| Background:Coagulation dysfunction is a significant component of liver disease,which can affect the prognosis of patients,and constitutes a key component of many prognostic scores.The coagulation mechanism of cirrhosis is more complex and often associated with thrombocytopenia and portal vein thrombosis(PVT).There are more complex associations between them,which have an impact on the prognosis of liver disease.The analysis of thrombocytopenia and PVT based on large-scale clinical data will help us to further understand the coagulation disorders in cirrhosis.Aim:(1)To evaluate the impact of baseline conditions and dynamic changes of platelet values on the 90-day prognosis of patients with acute-on-chronic liver diseases(AoCLD).(2)To assess the impact of PVT on the 90-day prognosis of patients with liver cirrhosis and the predictive value of MELD and MELD-Na scores on the 90-day prognosis of patients with PVT.(3)To assess the relationship between thrombocytopenia and PVT in patients with cirrhosis and its impact on the 90-day prognosis.Methods:Our study was based on the data of 3970 patients with liver disease in two multicenter prospective cohorts(NCT02457637,NCT03641872):(1)Patients were grouped according to their baseline platelet counts to assess the impact of platelets as a continuous variable or grade variable on the 90-day adverse outcomes;according to the changes in the platelet values of patients within 28 days,they were divided into reduced,stable,and increased groups,and analyzed their 90-day adverse outcomes.(2)Patients with cirrhosis were divided into groups with PVT and without PVT,and the difference in their 90-day prognosis was analyzed;MELD and MELD-Na scores were used to evaluate the 90-day prognosis of patients with PVT,and the applicability of the scores was analyzed.(3)Multivariate analysis of the correlation between thrombocytopenia and PVT was performed,and their impact on the 90-day prognosis was analyzed.Results:(1)Platelet count was inversely associated with the incidence of 90-day adverse outcomes in AoCLD patients(P for trend<0.001).The group with platelet count<20×109/L had the highest risk,with 36.8%of these patients having adverse outcomes within 90 days.The risk of a 90-day adverse outcome in patients increased by 5%for every 10×109/L decrease in platelet count below 210×109/L.(2)The cumulative incidence of 90-day liver transplantation(LT)-free mortality was comparable between the patients with and without PVT(log-rank P=0.0772).The MELD(area under the receiver operating curve[AUROC],0.637 vs.0.821,P=0.0042)and MELD-Na(AUROC,0.657 vs.0.835,P=0.0048)scores were independent predictors of 90-day mortality in patients with PVT.(3)85.5%of patients with cirrhosis had thrombocytopenia,which was independently related to PVT(OR 0.45,95%CI 0.32-0.63;P<0.001);PVT in patients with severe thrombocytopenia was related to gastrointestinal bleeding and ascites,but PVT was not an independent factor affecting the 90-day prognosis(P=0.522).Conclusions(1)Lower platelet counts were associated with 90-day adverse outcomes in patients with AoCLD and can help assess the patient’s prognosis.(2)PVT had no significant effect on the 90-day prognosis of patients with cirrhosis,but it affected the predictive value of MELD and MELD-Na scores,suggesting that the evaluation of LT needs to be considered more comprehensive.(3)Patients with cirrhosis and thrombocytopenia had a lower risk of PVT.Among patients with severe thrombocytopenia,PVT was related to the occurrence of gastrointestinal bleeding and ascites,but it was not an independent factor in the shortterm prognosis of patients. |
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