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1025
PLATELET COUNT AS A SCREENING TOOL FOR COMPENSATED
CIRRHOSIS
Pallavi Surana1, Julian Hercun2, Varun Takyar3, David E.
Kleiner4, Theo Heller5 and Christopher Koh5, (1)Liver Disease
Branch, National Institute of Diabetes and Digestive and Kidney
Diseases, (2)Liver Diseases Branch, National Institutes of
Diabetes and Digestive and Kidney Diseases, (3)University of
California, Los Angeles, (4)Laboratory of Pathology, National
Cancer Institute, (5)Liver Diseases Branch, National Institute
of Diabetes and Digestive and Kidney Diseases
Background: Platelet count has been used as a component of
non-invasive fibrosis scores and alone as a surrogate marker
for the screening of portal hypertension and varices (i e
Baveno VI criteria) Platelet count, solely, has not been used
as a non-invasive marker for the identification of cirrhosis.
With the discovery of effective therapies, management and
treatment of chronic viral hepatitis is often the responsibility of
primary care providers. A simplified means to detect cirrhosis
would therefore be beneficial to ensure optimal care and
potential referral to specialty care for management Objective:
To evaluate the clinical utility of a single routinely monitored
laboratory test in identifying cirrhosis, along with a cut-off
value, in chronic viral hepatitis patients. Methods: Clinical,
biochemical and histologic laboratory data from treatment
naive chronic viral hepatitis B (HBV), C (HCV), and D (HDV)
patients at the NIH Clinical Center were evaluated from 1985-
2019 Data was randomly divided into representative training
and validation cohorts Laboratory markers were tested for
their ability to identify cirrhosis (Ishak ≥5) using receiver
operating characteristic curves and an optimal cut-off by
Youden’s Index was calculated within the training cohort The
final cut-off was tested within the validation cohort. Results:
Overall, 1028 subjects (HCV=701, HBV=240 and HDV=86),
66% male, with mean (standard deviation) age of 45(11)
years were evaluated Within the training cohort (n=715),
platelets performed the best at identifying cirrhosis compared
to other laboratory markers (AUROC = 0 86 (0 82-0 90)) All
other tested markers (alanine aminotransferase, aspartate
aminotransferase, prothrombin time, alkaline phosphatase)
had AUROCs <= 0 77 The optimal platelet cut-off for detecting
cirrhosis in the entire cohort was 143 k/uL This cut-off value
performed equally well in the validation cohort (n=309) (Table
1) Conclusion: In patients with chronic viral hepatitis,
platelet counts can accurately stratify patients with cirrhosis
A platelet count >143 K/uL appears to have the most clinical
utility in ruling out cirrhosis The use of platelet counts should
be considered for ensuring optimal care and management of
patients with chronic viral hepatitis.
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发表于 2020-11-3 20:56