Association between platelet levels before selective plasmapheresis and in-hospital prognosis in patients with hepatitis B virus-related acute-on-chronic liver failure

Abstract

Abstract: Objective To explore the association between preoperative platelet levels of selective plasma exchange (SPE) and in-hospital prognosis in hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF).Methods A total of 129 patients with HBV-ACLF who received SPE intervention in Mengchao Hepatobiliary Hospital of Fujian Medical University from January 2017 to December 2020 were selected as the study subjects, and were divided into three groups according to the preoperative platelet levels of SPE: severe thrombocytopenia group (group A): <50×10⁹/L, moderate thrombocytopenia group (group B): 50~100×10⁹/L and normal group (group C): ≥100×10⁹/L, and the clinical characteristics of the three groups were compared. Multivariate logistic regression analysis found an independent association between preoperative platelet levels and in-hospital prognosis of HBV-ACLF after adjusting for potential confounders.Results Among the 129 patients with HBV-ACLF with SPE intervention, [gender: male/female=112/17, age: 45 (38,53) years], the end-stage liver disease model (MELD) score was 20.86 (18.41, 23.25), and the proportion of in-hospital adverse prognosis was 22.48% (29/129). Multivariate logistic regression analysis and adjustment for potential confounding factors showed that platelet level before SPE was an independent influencing factor for the in-hospital prognosis of HBV-ACLF. In the adjusted model II, the OR of group B and group C was 0.10 (95% CI: 0.01-0.78, P=0.029) and 0.01 (95% CI: 0.00-0.13, P<0.001), respectively, and the direction of effect after adjusting for confounding factors was consistent with that of the unadjusted confounding factors, and the P values of the trend test of platelet levels in the three groups were <0.001.Conclusion The preoperative platelet level of SPE was negatively correlated with the in-hospital prognostic risk of HBV-ACLF patients, and the higher the platelet level, the lower the risk of poor in-hospital prognosis. Patients with low platelet levels prior to SPE should receive more proactive monitoring, assessment and management to improve prognosis.

Key words: Platelet levels, hepatitis B virus, acute-on-chronic liver failure, selective plasma exchange, association

LIN Jian-hui, CHEN Li-xia, WEN Xin-xin, CHEN Ming, XIE Wen-guo, LIU Hai-yu. Association between platelet levels before selective plasmapheresis and in-hospital prognosis in patients with hepatitis B virus-related acute-on-chronic liver failure[J]. Chinese Hepatolgy, 2024, 29(12): 1527-1533.

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