Utility of Platelet Count for Predicting Cirrhosis in Alcoholic Liver Disease: Model for Identifying Cirrhosis in a US Population

Abstract

BACKGROUND: Thrombocytopenia has been shown to be the single most useful laboratory investigation for identifying subclinical cirrhosis of varying etiologies. However, alcohol per se can result in thrombocytopenia, and hence it is unclear whether platelet count can identify cirrhosis in patients who are alcoholic. OBJECTIVES: To characterize the utility of clinical predictors, especially platelet count, for identifying the presence of cirrhosis in alcoholics. To develop a simple, objective model for identifying cirrhosis in alcoholics. DESIGN: Retrospective cohort study. PARTICIPANTS: A total of 2,471 consecutive hospitalized patients with abnormal liver enzyme levels were screened, from which 272 patients with a history of recent and ongoing alcohol intake, negative diagnostic studies for alternative etiologies of chronic liver disease, and recent liver imaging with ultrasound or CT scan were included. MAIN MEASURES: Results of liver imaging and admission laboratory studies including liver enzymes, coagulation studies, and blood counts. KEY RESULTS: One hundred twenty-nine patients (47 %) had cirrhosis based on imaging; 143 patients (53 %) had no cirrhosis. A pre-sobriety platelet count (during ongoing alcohol intake) of less than 70*10 3 cells/ mm 3 was effective for ruling in cirrhosis (positive likelihood ratio [LR] 6.8, 95 % CI: 3.4, 14); platelet count greater than 200*10 3 was useful for ruling out cirrhosis in alcoholics (negative LR 0.18, 95 % CI: 0.10, 0.35). Multivariate logistic regression analysis identified international normalized ratio (INR) (p<0.01) and pre-sobriety platelet count (p<0.01) as independent predictors of cirrhosis. A Model for identifying Cirrhosis in Alcoholic Liver Disease (MCALD) was developed using the INR and pre-sobriety platelet count; it had an area under the receiver operating characteristic curve of 0.89 and Hosmer-Lemeshow goodness of fit chi 2 (p value) of 8.9 (0.35) for predicting cirrhosis in alcoholics. A MCALD score > 5.5 corresponded to an increased likelihood of cirrhosis (LR: 6.5, 95 % CI: 4.3, 11.0) and a MCALD score < 5.5 corresponded to decreased likelihood of cirrhosis in alcoholics (LR: 0.25, 95 % CI: 0.19, 0.36). Sobriety platelet count (after alcohol abstinence) at a cutoff of 160*10 3 had positive LR of 7.9 (95 % CI: 4.4, 14) and negative LR of 0.42 (95 % CI: 0.34, 0.52) for predicting cirrhosis in alcoholics.CONCLUSIONS: A simple model of platelet count and INR has good diagnostic accuracy for identifying cirrhosis in alcoholics.

Evaluation of aspartate amino transferase to platelet ratio index as a non invasive marker for liver cirrhosis

“…12 In another study by Murali et al, they found significant correlation between Platelet and alcoholic liver cirrhosis with the median platelet count of less than 70x103cells/mm 3 was effective for ruling in alcoholic cirrhosis and a platelet count greater than 200x103 cells/mm 3 significantly decreased the likelihood of having cirrhosis. 13 A recent meta-analysis by Udell et al, identified thrombocytopenia as the single most important laboratory test for identifying cirrhosis of varying etiologies. 14 In present study mean platelet count for HbsAg cirrhosis patients was 98.5x103 cells/mm 3 and that of non-cirrhosis were 1.92x103 cells/mm 3 which was significantly reduced.…”

Development of a model based on biochemical, real-time tissue elastography and ultrasound data for the staging of liver fibrosis and cirrhosis in patients with chronic hepatitis B

“…SPI and LFI were found to be independent predictors of significant fibrosis, whereas GGT, SPI and LFI were independent predictors of cirrhosis. Numerous previous studies have demonstrated that platelet count, AST level, and AST/ALT ratio are important predictors of significant fibrosis or cirrhosis ( 33 , 34 ). However, in the present study, only the GGT laboratory parameter was independently associated with cirrhosis, which is in agreement with the results of previous studies ( 35 , 36 ).…”

The clinical and economic burden of patients with chronic liver disease and thrombocytopaenia receiving platelet transfusions during planned invasive procedures

“…Thrombocytopaenia, or low platelet count, occurs in up to 50% of patients with chronic liver disease (CLD). It is the most common haematological complication in patients with CLD . Thrombocytopaenia may be caused by multiple factors including reduced platelet production due to decreased production of thrombopoietin, splenic sequestration of platelets and increased platelet destruction .…”

“…It is the most common haematological complication in patients with CLD. [1][2][3][4][5][6][7] Thrombocytopaenia may be caused by multiple factors including reduced platelet production due to decreased production of thrombopoietin, splenic sequestration of platelets and increased platelet destruction. 8 Patients with cirrhosis and other decompensated CLD are at a higher risk for thrombocytopaenia; one review of management of thrombocytopaenia in this population suggests that up to 78% of patients with cirrhosis have thrombocytopaenia.…”