The Prognostic Significance of the Platelet Count in Alcoholic Hepatitis

Overview

Journal Gastro Hep Adv

Specialty Gastroenterology

Date 2024 Aug 12

PMID 39130158

Authors

Jessie A Birnbaum

Howard S Herman

Qi Gao

Mordecai Koenigsberg

Samuel H Sigal

Affiliations

Soon will be listed here.

Abstract

Background And Aims: Thrombocytopenia is present in up to 76% of patients with chronic liver disease, and lower platelet counts (PCs) are associated with greater severity of portal hypertension. In this study, we assess the relationship of PC in patients with a clinical diagnosis of severe alcoholic hepatitis (SAH) with clinical severity and response to corticosteroid (CS) therapy.

Methods: Clinical characteristics, treatment, and hospital outcomes for patients admitted with SAH were analyzed from an electronic health record system. Patients were categorized based on admission PC (k/uL) into 5 categories: <50, 50-99, 100-149, 150-199, and ≥200. Frequency of complications (acute kidney injury, ascites, and hepatic encephalopathy), length of stay, and admission to an intensive care unit were analyzed across PC categories. Characteristics of patients who did and did not receive at least 4 days of CS therapy were compared.

Results: Among 159 patients, 15 (9.4%) were in the PC < 50 category, 42 (26.4%) in PC 50-99, 51 (32%) in PC 100-149, 23 (14.5%) in PC 150-199, and 28 (17.6%) in PC ≥ 200. A higher admission PC was associated with greater white blood cell count, absolute neutrophil count, and total bilirubin ( < .05). Patients with higher PC on admission were more likely to receive steroids. PC was inversely associated with Lille score at treatment day 4 ( < .05).

Conclusion: A higher PC in SAH was associated with a greater inflammatory response and total bilirubin. Patients with a higher PC were more likely to receive CS and have a favorable treatment response.

References

Thursz M, Richardson P, Allison M, Austin A, Bowers M, Day C . Prednisolone or pentoxifylline for alcoholic hepatitis. N Engl J Med. 2015; 372(17):1619-28. DOI: 10.1056/NEJMoa1412278. View

Rachakonda V, Gabbert C, Raina A, Li H, Malik S, DeLany J . Stratification of risk of death in severe acute alcoholic hepatitis using a panel of adipokines and cytokines. Alcohol Clin Exp Res. 2014; 38(11):2712-21. PMC: 4244659. DOI: 10.1111/acer.12558. View

Fujimoto M, Uemura M, Nakatani Y, Tsujita S, Hoppo K, Tamagawa T . Plasma endotoxin and serum cytokine levels in patients with alcoholic hepatitis: relation to severity of liver disturbance. Alcohol Clin Exp Res. 2000; 24(4 Suppl):48S-54S. View

Bissonnette J, Altamirano J, Devue C, Roux O, Payance A, Lebrec D . A prospective study of the utility of plasma biomarkers to diagnose alcoholic hepatitis. Hepatology. 2017; 66(2):555-563. DOI: 10.1002/hep.29080. View

Sheron N, Bird G, Goka J, Alexander G, Williams R . Elevated plasma interleukin-6 and increased severity and mortality in alcoholic hepatitis. Clin Exp Immunol. 1991; 84(3):449-53. PMC: 1535433. View

Thomopoulos K, Labropoulou-Karatza C, Mimidis K, Katsakoulis E, Iconomou G, Nikolopoulou V . Non-invasive predictors of the presence of large oesophageal varices in patients with cirrhosis. Dig Liver Dis. 2003; 35(7):473-8. DOI: 10.1016/s1590-8658(03)00219-6. View

Hardy T, Wells C, Kendrick S, Hudson M, Day C, Burt A . White cell count and platelet count associate with histological alcoholic hepatitis in jaundiced harmful drinkers. BMC Gastroenterol. 2013; 13(1):55. PMC: 3631132. DOI: 10.1186/1471-230X-13-55. View

Crabb D, Im G, Szabo G, Mellinger J, Lucey M . Diagnosis and Treatment of Alcohol-Associated Liver Diseases: 2019 Practice Guidance From the American Association for the Study of Liver Diseases. Hepatology. 2019; 71(1):306-333. DOI: 10.1002/hep.30866. View

Shirazi F, Singal A, Wong R . Alcohol-associated Cirrhosis and Alcoholic Hepatitis Hospitalization Trends in the United States. J Clin Gastroenterol. 2020; 55(2):174-179. DOI: 10.1097/MCG.0000000000001378. View

10.

Moon A, Curtis B, Mandrekar P, Singal A, Verna E, Fix O . Alcohol-Associated Liver Disease Before and After COVID-19-An Overview and Call for Ongoing Investigation. Hepatol Commun. 2021; 5(9):1616-1621. PMC: 8239751. DOI: 10.1002/hep4.1747. View

11.

Basra S, Anand B . Definition, epidemiology and magnitude of alcoholic hepatitis. World J Hepatol. 2011; 3(5):108-13. PMC: 3124876. DOI: 10.4254/wjh.v3.i5.108. View

12.

Crabb D, Bataller R, Chalasani N, Kamath P, Lucey M, Mathurin P . Standard Definitions and Common Data Elements for Clinical Trials in Patients With Alcoholic Hepatitis: Recommendation From the NIAAA Alcoholic Hepatitis Consortia. Gastroenterology. 2016; 150(4):785-90. PMC: 5287362. DOI: 10.1053/j.gastro.2016.02.042. View

13.

Kucybala I, Ciuk S, Teczar J . Spleen enlargement assessment using computed tomography: which coefficient correlates the strongest with the real volume of the spleen?. Abdom Radiol (NY). 2018; 43(9):2455-2461. PMC: 6105139. DOI: 10.1007/s00261-018-1500-9. View

14.

Liang X, Xiu C, Liu M, Lin C, Chen H, Bao R . Platelet-neutrophil interaction aggravates vascular inﬂammation and promotes the progression of atherosclerosis by activating the TLR4/NF-κB pathway. J Cell Biochem. 2018; 120(4):5612-5619. DOI: 10.1002/jcb.27844. View

15.

Cowan D, HINES J . Thrombocytopenia of severe alcoholism. Ann Intern Med. 1971; 74(1):37-43. DOI: 10.7326/0003-4819-74-1-37. View

16.

Mitchell O, Feldman D, Diakow M, Sigal S . The pathophysiology of thrombocytopenia in chronic liver disease. Hepat Med. 2016; 8:39-50. PMC: 4847598. DOI: 10.2147/HMER.S74612. View

17.

Thompson J, Martinson N, Martinson M . Mortality and costs associated with alcoholic hepatitis: A claims analysis of a commercially insured population. Alcohol. 2018; 71:57-63. DOI: 10.1016/j.alcohol.2018.02.003. View

18.

Brown Jr R . Current Management of Thrombocytopenia in Chronic Liver Disease. Gastroenterol Hepatol (N Y). 2019; 15(3):155-157. PMC: 6495413. View

19.

Kaser A, Brandacher G, Steurer W, Kaser S, Offner F, Zoller H . Interleukin-6 stimulates thrombopoiesis through thrombopoietin: role in inflammatory thrombocytosis. Blood. 2001; 98(9):2720-5. DOI: 10.1182/blood.v98.9.2720. View

20.

Foncea C, Sporea I, Lupusoru R, Moga T, Bende F, Sirli R . Day-4 Lille Score Is a Good Prognostic Factor and Early Predictor in Assessing Therapy Response in Patients with Liver Cirrhosis and Severe Alcoholic Hepatitis. J Clin Med. 2021; 10(11). PMC: 8198529. DOI: 10.3390/jcm10112338. View