Antimicrobial-Induced Cytopenia and Bone Marrow Hypocellularity in Patients with Cirrhosis.

Anupama Patil,Monika Thakur,Chhagan Bihari,Vikas Khillan,Pratibha Kale

doi:10.1155/2018/4029648

Anupama Patil, Monika Thakur + Show 3 more

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https://doi.org/10.1155/2018/4029648

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Journal: Bone marrow research	Publication Date: May 14, 2018
Citations: 2	License type: CC BY 4.0

Affiliation: Institute of Liver and Biliary Sciences

Abstract

There is great variation in cytopenias in cirrhotic patients with same severity and hypersplenism and their causative factors are not clear. Recent studies have highlighted the role of gut microbiome in regulation of constant and emergency hematopoiesis. Broad-spectrum antibiotics can disrupt the homeostatic or adaptive microbiota in cirrhosis, leading to impaired hematopoiesis and a higher susceptibility to infections. We studied all patients with cirrhosis with cytopenia (anemia, leucopenia, and/or thrombocytopenia), admitted in the Institute of Liver & Biliary Sciences, between January 2016 and July 2017, who underwent a bone marrow examination. The effect of the different antimicrobial agents on peripheral blood counts and bone marrow cellularity was assessed. A total of 196 patients' data was analyzed for this study. Patients on antimicrobials (n = 115) had significantly lower hemoglobin (p < 0.001), total leucocyte count (p = 0.048), and platelet count (p = 0.043) compared to patients not on antimicrobials. On unadjusted analysis, significant association with thrombocytopenia existed in beta-lactams (OR = 1.56, 95% CI = 1.06–2.40), quinolones (OR = 1.66, 95% CI = 1.11–2.61), and antifungals (OR = 2.24, 95% CI = 1.96–4.34). Cephalosporins were found to be significantly associated with anemia (OR = 1.91, 95% CI = 1.07–3.41). Patients who received antimicrobials had hypocellular marrow (p < 0.001) as compared to nonrecipients of antibiotics. The adjusted analysis showed that quinolones and beta-lactam antibiotics are the drug classes having significant association with thrombocytopenia and alternative class of drug should be explored in these patients to avoid severe thrombocytopenia.

Highlights

Patients of chronic liver disease (CLD) and end-stage cirrhosis have varying grades of cytopenia and other hematologic derangements either due to the compromised synthetic capacity of the diseased liver itself or resulting from the innumerable medical or surgical insults [1]
There was no statistically significant difference in the outcomes of the patients in the two groups [Table 1]. This is the first study to evaluate the risk of cytopenias associated with the use of commonly prescribed antimicrobial agents in the specific cohort of patients with CLD
The adjusted analysis showed that quinolones and beta-lactam antibiotics were the only drug classes with a statistically significant association with thrombocytopenia

Summary

Introduction

Patients of chronic liver disease (CLD) and end-stage cirrhosis have varying grades of cytopenia and other hematologic derangements either due to the compromised synthetic capacity of the diseased liver itself or resulting from the innumerable medical or surgical insults [1]. These patients experience complications related to uni- or multilineage peripheral cytopenias. The grades of cytopenias in patients with same severity of CLD and their causative factors are not clear. It is possible that there may be interplay of numerous other factors that cause cytopenias in these patients

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