Grading of Peripheral Cytopenias due to Splenomegaly and Hepatitis B Cirrhotic Portal Hypertension

Abstract

Background: Splenomegaly due to hepatitis B cirrhotic portal hypertension is common in clinical practice, and it is often complicated by monolineage or multilineage cytopenias. We attempted to answer the following questions based on our 20 years of observation and research: can peripheral cytopenias be graded and what are the effects of peripheral cytopenia grades on clinical outcomes? Objectives: This study aimed to investigate the grading of peripheral cytopenia in patients with splenomegaly due to hepatitis B cirrhotic portal hypertension and its effect on clinical outcomes. Methods: Data from 330 patients with splenomegaly due to hepatitis B cirrhotic portal hypertension were collected from January 1991 to December 2011. All data were analysed with SPSS 13.0. Univariate and multivariate analyses were performed. The various forms of cytopenia were scored and graded according to the F value of the multiple linear regression equation. Depending mainly on the severity, cytopenia was graded as mild, moderate, or severe, and was given a total score of 3 points, respectively. Their relationships with clinical outcomes on follow up (cured, improved, no change or dead) were then compared. Results: All patients in this study were treated with splenectomy +/- devascularization or total porto-systemic shunting operation. Of 330 patients, 99 (30%) patients had monolineage cytopenia, 118 (35.8%) bilineage cytopenia, and 113 (34.2%) trilineage cytopenia. On univariate analysis, severity of erythropenia was related to a significant difference in surgical outcome on intra-group comparison (P<0.05). On multivariate analysis, thrombocytopenia was related to a significant difference in surgical outcome when compared with leukopenia and erythropenia (P<0.05). A significant difference in surgical outcome existed among the three grades (mild, moderate, and severe) of cytopenia (P<0.05). Conclusion: Peripheral cytopenias had significant impact on clinical outcomes. The more severe the cytopenias, the worse the surgical outcomes. Thrombocytopenia was a major factor affecting surgical outcomes. The thrombocytopeniabased three-level grading of cytopenia provided a basis for analyzing individual patients, planning treatment, and assessing prognosis in clinical practice.