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Incidence, prevalence and clinical significance of abnormal hematological indices in compensated cirrhosis
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Background & Aims: Patients with cirrhosis develop abnormal hematologic indices (HI) from multiple factors, including hypersplenism. We aimed to analyze the sequence of events and determine whether abnormal HI has prog-nostic significance. Methods: We analyzed a database of 213 subjects with compensated cirrhosis without esopha-geal varices. Subjects were followed for approximately 9 years until the development of varices or variceal bleeding or completion of the study; 84 subjects developed varices. Abnormal HI was defined as anemia at baseline (hemoglo-bin,<13.5 g/dL for men and 11.5 g/dL for women), leuko-penia (white blood cell counts,<4000/mm 3 ), or thrombo-cytopenia (platelet counts, < 150,000/mm 3 ). The primary end points were death or transplant surgery. Results: Most subjects had thrombocytopenia at baseline. Kaplan-Meier analysis showed that leukopenia occurred by 30 months (95% confidence interval, 18.5-53.6), and anemia occurred by 39.6 months (95% confidence interval, 24.1-49.9). Baseline thrombocytopenia (P .0191) and leukope-nia (P.0383) were predictors of death or transplant, after adjusting for baseline hepatic venous pressure gradient (HVPG), and Child-Pugh scores. After a median of 5 years,a significant difference in death or transplant, mortality,and clinical decompensation was observed in patients who had leukopenia combined with thrombocytopenia at base- line compared with patients with normal HI (P < .0001). HVPG correlated with hemoglobin and white blood cell count (hemoglobin, r 0.35, P < .0001; white blood cell count, r 0.31, P < .0001). Conclusions: Thrombocy-topenia is the most common and first abnormal HI to occurin patients with cirrhosis, followed by leukopenia and anemia. A combination of leukopenia and thrombocytopenia at baselin predicted increased morbidity and mortality.
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QAMAR, A. a., GRACE, N. d., GROSZMANN, Roberto j., GARCIA TSAO, Guadalupe, BOSCH I GENOVER, Jaume, BURROUGHS, Andrew k., RIPOLL, Cristina, MAURER, R., PLANAS, R., ESCORSELL I MAÑOSA, M. àngels, GARCÍA PAGÁN, Juan carlos, PATCH, D., MATLOFF, D. s., MAKUCH, R., RENDON, G.. Incidence, prevalence and clinical significance of abnormal hematological indices in compensated cirrhosis. _Clinical Gastroenterology and Hepatology_. 2009. Vol. 7, núm. 6, pàgs. 689-695. [consulta: 30 de gener de 2026]. ISSN: 1542-3565. [Disponible a: https://hdl.handle.net/2445/47248]