Effect of presence of severe thrombocytopenia on prognosis of hepatic patients in intensive care unit

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed Ali Fawaz Ahmed ◽  
Ahmed Mohammed Elsayed Elhenawy ◽  
Wael Abd-Almonem M Abd-Alwahab ◽  
Mahmoud Salem Elsayed Salem
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Platelet Count ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
Chronic Liver ◽  
Apache Ii Score ◽  
Severe Thrombocytopenia ◽  
Normal Platelet Count ◽  
Normal Platelet

Abstract Background Thrombocytopenia is defined as a platelet count below 150,000/μL.It is the most common hematological complication in patients with chronic liver disease (CLD).The prevalence of thrombocytopenia in chronic liver diseases ranges from 6 % among non-cirrhotic patients with chronic liver disease to 70 % among patients with liver cirrhosis. Objective To investigate the association between thrombocytopenia and the risk of higher mortality incidence in hepatic patients in intensive care unit. Patients and Methods The present prospective cohort study was conducted at Ain Shams University hospitals Intensive care units, from October 2019 to August 2020. After obtaining approval of the study protocol from the local ethical committee, as well as fully informed consents signed by the patient closet relative, 130 hepatic patients admitted at ICU with hepatic coma and patients classified according to platelet count on admission into two equal groups. Group A: included 65 Patients with thrombocytopenia on admission (<100,000/μL). Group B: included 65 Patients with normal platelet count on admission with persistently normal platelet count (≥100,000/μL). Results Our study revealed that patients with lower platelet counts had significantly higher risk of death and ICU stay. In our study we showed that there are two independent risk factors affecting the outcome of hepatic patients in the ICU they were thrombocytopenia and high APACHE score. These observations highlight the potential importance of low platelets count in identifying a group of hepatic patients who are at risk for poorer prognosis. Conclusion Thrombocytopenia is a frequent laboratory finding among hepatic patients, which is generally correlated to the severity of illness. Thrombocytopenia is generally associated with higher APACHE II score when compared to normal platelet count indicating that it is associated with higher degree of morbidity and expected higher mortality rate.

scholarly journals Lusutrombopag is effective and safe in patients with chronic liver disease and severe thrombocytopenia: a multicenter retrospective study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Hiroaki Nomoto ◽  
Naoki Morimoto ◽  
Kouichi Miura ◽  
Shunji Watanabe ◽  
Yoshinari Takaoka ◽  
...  
Keyword(s):  
Platelet Count ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
Platelet Transfusion ◽  
Chronic Liver ◽  
Severe Thrombocytopenia ◽  
Invasive Procedures ◽  
Significance Level ◽  
Group A ◽  
Group B

Abstract Background Chronic liver disease (CLD) is often complicated by severe thrombocytopenia (platelet count < 50,000/µL). Platelet transfusion has been a gold standard for increasing the platelet count to prevent hemorrhagic events in such patients. Lusutrombopag, a thrombopoietin receptor agonist, can increase the platelet count in such patients when invasive procedures are scheduled. Former studies on lusutrombopag included patients with a platelet count of > 50,000/µL at baseline: the proportions of patients who did not require platelet transfusion were 84–96%, which might be overestimated. Methods The efficacy and safety of lusutrombopag were retrospectively investigated in CLD patients with platelet count of < 50,000/µL, a criterion for platelet transfusion, in real-world settings. We examined the proportion of patients who did not require platelet transfusion in 31 CLD patients, which exceeded a minimum required sample size (21 patients) calculated by 80% power at a significance level of 5%. Lusutrombopag, 3 mg once daily, was administered 8–18 days before scheduled invasive procedures. Results Among 31 patients who received lusutrombopag, 23 patients (74.2%) patients showed a platelet count of ≥ 50,000/µL (Group A) and did not require platelet transfusion. The remaining 8 patients (25.8%) did not reached platelet ≥ 50,000/µL (Group B). The means of platelet increase were 38,000/µL and 12,000/µL in groups A and B, respectively. A low platelet count at baseline was a characteristic of patients in group B. Among 13 patients who repeatedly used lusutrombopag, lusutrombopag significantly increased the platelet count as the initial treatment. When all repeated uses of lusutrombopag were counted among these 13 patients, platelet transfusion was not required in 82.1% (23/28) of treatments. Although one patient showed portal thrombosis after lusutrombopag treatment, the thrombosis was disappeared by anticoagulant treatment for 35 days. The degree of platelet increase with lusutrombopag was larger than that in their previous platelet transfusion. Conclusions The proportion of patients who did not require platelet transfusion was 74.2%, which is smaller than that in former studies which included CLD patients with a platelet count of > 50,000/µL. However, lusutrombopag is effective and safe for CLD patients with a platelet count of < 50,000/µL.

Impact of chronic liver disease in intensive care unit acquired pneumonia: a prospective study

2013 ◽  
Vol 39 (10) ◽  
pp. 1776-1784 ◽  
Author(s):  
Marta Di Pasquale ◽  
Mariano Esperatti ◽  
Ernesto Crisafulli ◽  
Miquel Ferrer ◽  
Gianluigi Li Bassi ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Liver Disease ◽  
Prospective Study ◽  
Chronic Liver Disease ◽  
Chronic Liver ◽  
A Prospective Study

Risk Factors for Transition From Normal Platelet Count to Severe Thrombocytopenia Among Patients with Chronic Liver Disease.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 3518-3518
Author(s):  
Elizabeth V Lawler ◽  
Jennifer R Fonda ◽  
Ruslan V. Horblyuk ◽  
Kelly M. Grotzinger ◽  
Cara McLaughlin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Platelet Count ◽  
Liver Disease ◽  
Hepatitis C ◽  
Chronic Liver Disease ◽  
Drug Dependence ◽  
Chronic Liver ◽  
Platelet Counts ◽  
Normal Platelet

Abstract Abstract 3518 Poster Board III-455 Introduction Thrombocytopenia [TCP] is a complication of advanced chronic liver disease [CLD]. We examined clinical factors related to the development of severe TCP among patients with initially normal platelet counts using laboratory, clinical, and administrative data from the Veterans Administration Healthcare System, New England region. Methods All patients with a diagnosis of CLD or hepatitis C who were seen in a VA hospital or in a VA outpatient clinic between 10/2002 and 9/2008 were included in this analysis. CLD diagnosis definitions included: 1) ICD9-CM code of 51.0 – 571.9, excluding 571.1at a clinic visit or hospital discharge 2) positive hepatitis C [Hep-C] antibody, and 3) elevated ALT (> 84 IU/dL) on two occasions at least 60 days. Subjects were required to have normal platelet counts (platelet count >150,000/μL) at baseline. Subjects were excluded if they had the following: 1) hepatorenal syndrome, coagulation disorders, immune TCP purpura, lupus erythematosis, rheumatoid arthritis, pernicious anemia, aplastic anemia or septicemia. Severe TCP was defined as a platelet count < 50,000/μL. Risk factors evaluated for the development of TCP included age, comorbidities (diabetes, alcoholic and/or drug dependence, chronic kidney disease, Hepatitis-C [Hep-C] status, hepatorenal syndrome, congestive heart failure [CHF], coronary artery disease, hypertension), resource utilization (infectious disease, gastrointestinal [GI] nephrology and/or hematology clinic visit), and current laboratory values (hemoglobin, ALT and MELD Score). All potential predictors were treated as time-varying exposures over the follow-up and updated at each interval. Relative risk was estimated using logistic regression with pooled repeated observations, using 3-month periods where risk factors at the beginning of a 3-month interval were used to predict severe TCP in that interval. Results 6,102 subjects with Hep-C contributed a median follow-up of 1,414 days and had 82 events (1.34%) during the study. 5,358 Non Hep-C subjects contributed a median follow-up of 1,238 days and had 97 events (1.81%) during the study. The median platelet count among CLD patients at baseline was 238,000/μL (IQR 203,000/μL- 282,000/μL) and among Hep-C patients at baseline was 240,000 (IQR 205,000/μL- 285,000/μL). After multivariate adjustment, alcohol dependence [Odds ratio = 2.24, 95% confidence interval: (1.14, 4.39)], CHF [2.6 (1.05,6.43)], 5 unit change in MELD [1.13 (1.05,1.21)], GI clinic visits [1.89 (0.93,3.87)] and anti retroviral therapy [3.84 (1.60, 7.61)] increased the odds of severe TCP; while drug dependence [0.62 (0.34, 1.13)] and increasing hemoglobin [0.74 (0.65,0.84)] reduced the odds of severe TCP. In non Hep-C subjects, alcohol dependence [2.88 (1.58,5.25)], CHF [1.81 (0.9, 3.65)], 5 unit change in MELD [1.12 (1.03, 1.23)], hematology clinic [3.64 (1.91, 6.93)] current anti-retroviral therapy [6.65 (1.96, 22.6)] and ALT 42-84g/dL vs. ALT < 42g/dL [1.55 (0.78, 3.06)] increased the odds of severe TCP; while drug dependence [0.46 (0.17, 1.22)], increasing hemoglobin [0.68 (0.60, 0.78)] and ALT > 84g/dL vs. ALT < 42 reduced the odds of severe TCP. Conclusions In a population of veterans with chronic liver disease or hepatitis C infection with normal platelet counts > 150,000/μL at baseline, we estimate the incidence of development of severe thrombocytopenia to be between 1 and 2% over an average of 3 years of follow-up. Key clinical predictors of development of severe TCP included prevalent CHF diagnosis and changing MELD score. Specialist care referrals to hematologists and gastroenterologists, also identified patients likely to become severe TCP cases. As expected, antiretroviral therapies were associated with an increased risk of severe TCP over the follow-up. Acknowledgments GlaxoSmithKline provided research support for this project, with no restrictions on publication. The study was conducted using resources of the VA Cooperative Studies Program and VA Boston Healthcare System. Disclosures: Lawler: GlaxoSmithKline: Research Funding. Horblyuk:GlaxoSmithKline: Employment. Grotzinger:GlaxoSmithKline: Employment, Research Funding.

Role of severe thrombocytopenia in preventing platelet count recovery in thrombocytopenic patients with chronic liver disease

2019 ◽  
Vol 35 (2) ◽  
pp. 299-304 ◽  
Author(s):  
Masashi Hirooka ◽  
Hironori Ochi ◽  
Atsushi Hiraoka ◽  
Yohei Koizumi ◽  
Takaaki Tanaka ◽  
...  
Keyword(s):  
Platelet Count ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
Chronic Liver ◽  
Severe Thrombocytopenia ◽  
Count Recovery

scholarly journals Impact of Co-morbidities on Outcome of COVID-19 Patients: An Observational Study among Patients Admitted to Intensive Care Unit

2021 ◽  
Author(s):  
Hemant Kumar ◽  
Sumeet Dixit ◽  
Nikhil Gupta ◽  
Preeti Gupta ◽  
Manoj Kumar Pandey ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Liver Disease ◽  
Observational Study ◽  
Chronic Liver Disease ◽  
Adverse Outcomes ◽  
Chronic Liver ◽  
North India ◽  
P Value ◽  
Tertiary Teaching

Introduction: Coronavirus Disease-2019 (COVID-19) has been a major cause of apprehension, morbidity, and mortality in 2020. It had been postulated that associated co-morbid conditions in COVID-19 patients increase the severity of COVID-19 which leads to six times more chances of hospitalisation than patients without co-morbid condition. Mortality is also 12 times higher in such patients. Aim: To find out the association between co-morbidities and mortalities due to COVID-19 pneumonia. Materials and Methods: A prospective, observational study was conducted in a tertiary teaching institute of North India which was designated Level 3 (L-3) facility for treatment of COVID- 19 patients. All 109 COVID-19 patients confirmed by Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR), admitted in Intensive Care Unit (ICU) from 1st July 2020 to 30th November 2020 formed the sample of the study. Data was taken regarding past history, clinical histories and examinations and ICU care and treatments. Based on their final outcome at the end of ICU care, patients were divided into two groups-group 1 (Non-survivor or Expired) and group 2 (Survived) and intergroup differences were studied. Results: COVID-19 infection was about three times more common in males. Severe category of COVID-19 patients had higher mortality (59.2% of severe category expired during hospital course, 1.7% patients expired in moderate category group). Most common co- morbidities were hypertension (n=51, 46.8%) and diabetes (n=48, 44%). Multivariate analysis showed that co-morbidities in the form of chronic liver disease (OR -0.127 (0.024-0.681, p-value 0.016)) and post tubercular sequel (OR 0.036 (0.003-0.442, p-value 0.009)) were less likely to occur in COVID-19 patients who survived, thus making these co-morbidities significant contributor to the adverse outcomes in COVID-19 patients. More number of co-morbidities in a patient were associated with higher chance of mortality and this trend was significant statistically (p-value <0.001). Conclusion: Patients with multiple co-morbidities, chronic liver disease and post tubercular sequel were associated with higher mortality in COVID-19 patients.

scholarly journals Lusutrombopag is Effective and Safe in Patients with Chronic Liver Disease and Severe Thrombocytopenia: A Multicenter Retrospective Study

2020 ◽  
Author(s):  
Hiroaki Nomoto ◽  
Naoki Morimoto ◽  
Kouichi Miura ◽  
Shunji Watanabe ◽  
Yoshinari Takaoka ◽  
...  
Keyword(s):  
Platelet Count ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
Platelet Transfusion ◽  
Chronic Liver ◽  
Severe Thrombocytopenia ◽  
Invasive Procedures ◽  
Group A ◽  
Low Platelet Count ◽  
Group B

Abstract Background: Chronic liver disease (CLD) is often complicated by severe thrombocytopenia (platelet count <50,000/µL). Platelet transfusion has been a gold standard for increasing the platelet count to prevent hemorrhagic events in such patients. Lusutrombopag, a thrombopoietin receptor agonist, can increase the platelet count in such patients when invasive procedures are scheduled. However, we have little information on the effect of lusutrombopag in CLD patients with severe thrombocytopenia in real-world settings.Methods: To investigate the efficacy and safety of lusutrombopag in patients with chronic liver disease and severe thrombocytopenia, we retrospectively investigated 26 CLD patients with a platelet count of <50,000/µL. Lusutrombopag, 3 mg once daily, was administered 8-15 days before scheduled invasive procedures.Results: Among 26 patients who received lusutrombopag, 19 patients (73.1%) patients showed a platelet count of ≥50,000/µL (Group A) and did not require platelet transfusion. The remaining 7 patients (26.9%) did not reached platelet ≥50,000/µL (Group B). The means of platelet increase were 36,000/µL and 13,000/µL in groups A and B, respectively. A low platelet count at baseline was a characteristic of patients in group B. Among 13 patients who repeatedly used lusutrombopag, lusutrombopag significantly increased the platelet count as the initial treatment. No adverse events were noted during or after lusutrombopag treatment. In addition, the degree of platelet increase with lusutrombopag was larger than that in their previous platelet transfusion.Conclusions: Lusutrombopag is effective and safe for CLD patients with a platelet count of <50,000/µL.

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