Comparative study of platelet indices in cirrhosis, cirrhosis with sepsis and normal population

Abstract

Cirrhosis is defined as the histological development of regenerative nodules surrounded by fibrous bands in response to chronic liver injury that leads to portal hypertension and end stage liver disease. Abnormal hematological indices (HI) are common in cirrhosis with a prevalence ranging from 6% to 77% in various studies. 1 Platelets are non-nucleated cell fragments derived from megakaryocytes, most often present in the bone marrow. Studies show that platelets produced from megakaryocytes present in the microvasculature is governed by circulatory forces. 2 Thrombocytopenia was the most common and earliest HI abnormality to develop in cirrhosis. 1 MPV is the measure of average size of platelets in circulation, and PDW is an index reflecting the heterogeneity of platelets. Platelet activation leads to changes in platelet shape with increase in platelet size ABSTRACT Background: Platelet indices are the first hematologic indices to be affected in cirrhosis. Cirrhosis patients are particularly susceptible to bacterial infections. The incidence of sepsis in cirrhosis is estimated to be at least 30-50% of hospital admissions. Sepsis also causes alterations in platelet indices. We studied and compared the platelet indices namely platelet count, mean platelet volume (MPV), platelet distribution width (PDW) and platecrit in cirrhosis, cirrhosis with sepsis and normal control population. Methods: This observational study included forty cirrhosis, forty three cirrhosis with sepsis and sixty one controls. Platelet indices were reviewed and compared between the groups and correlation of platelet indices with CTP score, MELD, platelet count and spleen size was also evaluated. Results: Platelet indices were significantly altered in cirrhosis compared to normal population. MPV and PDW were significantly higher in cirrhosis compared to control population. Platelet count and platecrit were significantly lower in cirrhosis compared to control population. CTP score and MELD showed significant positive correlation with MPV and platelet count showed significant negative correlation with PD. Sepsis in cirrhosis was associated with significant decrease in platelet count and platecrit but caused significant increase in PDW compared to cirrhosis without sepsis. Cirrhosis with sepsis group had four patients with variceal bleeding with significantly higher mean PDW(19%) and significantly lower mean platecrit (0.04) compared to nonbleeding group (p value <0.05). Conclusions: Platelet indices are useful parameters in cirrhosis. Other than platelet count, PDW and platecrit are useful indices to be monitored in cirrhosis with sepsis.