Cut-off Values Of Platelet Count Research Articles

#5319 ACCURACY OF PLATELET INDICES AS PREDICTOR OF IN-HOSPITAL MORTALITY IN PATIENTS WITH ACUTE KIDNEY INJURY REQUIRING RENAL REPLACEMENT THERAPY

Abstract Background and Aims Acute kidney injury (AKI) is a major medical complication associated with a markedly increased risk of death, particularly in patients admitted to the ICU where in-hospital mortality exceeds 50%1. This study aimed to determine the accuracy of MPV, platelet count, and PDW as predictors of adverse outcomes in patients with AKI who received initiation renal replacement therapy (RRT). Method A retrospective cohort single-center study was done in a local private tertiary hospital in Cebu. Four hundred ninety-one patients with AKI who underwent RRT between January 2018 and December 2021 were enrolled. A retrieval of data on demographic and clinical parameters during the initiation of RRT was done. The impact of mortality-related factors were identified using univariate and multivariate logistic regression analysis. Determination of optimal cut-off values of platelet indices for in-hospital mortality was done. Results This study showed that the in-hospital mortality of patients was 58.45%, with a mean age of 68.6 ± 16.28 years among non-survivors. Among the platelet indices, platelet count and PDW were good predictors of in-hospital mortality in patients who received initiation renal replacement therapy. The optimal cut-off value of platelet count was 173 × 103/uL (sensitivity 56.45%, specificity 62.25%, PPV 67.78%, NPV 50.40%, AUC 0.604). The optimal cut-off value of PDW was 16.45% (sensitivity 50.87%, specificity 71.57%, PPV 71.57%, NPV 50.87%, AUC 0.611). Conclusion Platelet indices are feasible parameters that can be used as prognostic markers for mortality in patients with AKI requiring RRT. The in-hospital mortality of patients with AKI requiring initiation RRT is high (58.45%). Low platelet counts, high MPV values, and high PDW values are associated with poorer outcomes and higher mortality risk as compared to patients with normal indices.

#5304 ACCURACY OF PLATELET INDICES AS PREDICTOR OF IN-HOSPITAL MORTALITY IN PATIENTS WITH ACUTE KIDNEY INJURY REQUIRING RENAL REPLACEMENT THERAPY

Abstract Background and Aims Acute kidney injury (AKI) is a major medical complication associated with a markedly increased risk of death, particularly in patients admitted to the ICU where in-hospital mortality exceeds 50%1. This study aimed to determine the accuracy of MPV, platelet count, and PDW as predictors of adverse outcomes in patients with AKI who received initiation renal replacement therapy (RRT). Method A retrospective cohort single-center study was done in a local private tertiary hospital in Cebu. Four hundred ninety-one patients with AKI who underwent RRT between January 2018 and December 2021 were enrolled. A retrieval of data on demographic and clinical parameters during the initiation of RRT was done. The impact of mortality-related factors were identified using univariate and multivariate logistic regression analysis. Determination of optimal cut-off values of platelet indices for in-hospital mortality was done. Results This study showed that the in-hospital mortality of patients was 58.45%, with a mean age of 68.6 ± 16.28 years among non-survivors. Among the platelet indices, platelet count and PDW were good predictors of in-hospital mortality in patients who received initiation renal replacement therapy. The optimal cut-off value of platelet count was 173 x 103/uL (sensitivity 56.45%, specificity 62.25%, PPV 67.78%, NPV 50.40%, AUC 0.604). The optimal cut-off value of PDW was 16.45% (sensitivity 50.87%, specificity 71.57%, PPV 71.57%, NPV 50.87%, AUC 0.611). Conclusion Platelet indices are feasible parameters that can be used as prognostic markers for mortality in patients with AKI requiring RRT. The in-hospital mortality of patients with AKI requiring initiation RRT is high (58.45%). Low platelet counts, high MPV values, and high PDW values are associated with poorer outcomes and higher mortality risk as compared to patients with normal indices.

Platelet Count as a Predictor for Community-Acquired Pneumonia Severity Using PSI Score

Community-Acquired pneumonia (CAP) refers to the inflammation of the lung parenchyma that is contracted outside of a hospital setting. In addition, in developing countries, it is among the top three causes of death worldwide. Pneumonia severity is often assessed using various instruments, including Pneumonia Severity Index (PSI). Furthermore, the platelet play a crucial role in both hemostasis and the defense of the body against infectious agents. A relatively inexpensive and routinely conducted test, namely the platelet count serves as a supporting examination. Therefore, this study aimed to determine the potential correlation between the platelet count and CAP severity. Aims: The objective of this study was to investigate the potential role of platelet count as a predictive factor for evaluating the severity of CAP patients using PSI scores. Methodology: An analytical observational study with a retrospective cross-sectional design was conducted on patients diagnosed with CAP at Dr. Moewardi General Hospital Surakarta from October 2022 to May 2023. Patients data were extracted from medical records. The correlation between the platelet count and CAP severity was analysed using the Spearman correlation test. The platelet count cut-off value was determined using Receiver Operating Characteristic (ROC) curve. Results: In this study, there were 183 subjects with an average age of 56.90 and a platelet count of 272,688.52 (SD ± 157,524.87). The CAP severity was dominated by the moderate-severe category (52.5%). The platelet count was negatively correlated with severity based on PSI score with p=0.029 (p<0.05) and r=0.162 (low correlation value). Based on ROC curve, AUC value = 0.594 (very weak predictor) and the platelet count cut-off value was 152,000 (sensitivity = 0.322, specificity = 0.91). Scientific Novelty: There is a correlation between the platelet count and the severity of CAP based on the PSI score. Conclusion: A significant correlation was found between the platelet count and CAP severity based on PSI score. However, the platelet count could not be used as a reliable predictor of CAP severity.

Is there a change in platelet indices among pregnant with antiphospholipid syndrome?

Introduction: Recurrent pregnancy loss (RPL) is a common obstetrical complication, but 50% of cases have an undetermined etiology. Antiphospholipid syndrome (APL) is an autoimmune disease that has been linked to RPL. Platelet abnormalities, particularly thrombophilia, have been linked to RPL. Objectives: This study examined the change in platelet parameters, specifically, platelet count, mean platelet volume (MPV), and platelet distribution width (PDW), in patients presenting with RPL caused by APL. Patients and Methods: Fifty women with a confirmed diagnosis of APL syndrome with a history of RPL were assigned as a study group, and 50 women who gave birth without RPL were healthy controls. Pregnant women were recruited from Al Yarmouk teaching hospital. Personal data were collected through direct interviews with patients, followed by blood samples that were analyzed for complete blood counts and platelet indices. Results: Both platelet count and PDW showed a significant correlation with the number of pregnancy losses; Pearson’s correlation coefficient was (r=0.74, and r=0.59) for platelet count and PDW. The receiver operating characteristic (ROC) calculated a platelet count cut-off value of 230, with 88% sensitivity and 84% specificity, an area under the curve (AUC) of 0.89, and a P value of 0.001. The PDW had a cut-off value of 13.6 fl/L, associated with 88% sensitivity, 80% specificity, AUC=0.87, and a P value <0.001. Conclusion: Platelet indices may aid gynecologists in low-resource settings in predicting high-risk pregnancies deemed to suffer from RPL.

Systemic inflammation with sarcopenia predicts survival in patients with gastric cancer.

The levels of platelet-related inflammation indicators and sarcopenia have been reported to affect the survival of patients with cancer. To evaluate the prognostic influence of platelet count (PLT), platelet lymphocyte ratio (PLR), and systemic immune inflammation index (SII), and SII combined with sarcopenia on the survival of patients with gastric cancer (GC). A total of 1133 patients with GC (812 male and 321 female, average age: 59.43years) were evaluated. Receiver-operating characteristic curves were used to determine the best cutoff values of PLT, PLR, and SII, and univariate and multivariate Cox risk regression models were used to evaluate whether SII is an independent predictor of overall survival (OS). The prognostic SS (SII-sarcopenia) was established based on SII and sarcopenia. Finally, a comprehensive analysis of the prognostic SS was performed. SII had the strongest prognostic effect. The SII and OS of patients with GC were in an inverted U-shape (adjusted HR = 1.07; 95% CI 0.97-1.19; adjusted P = 0.179). In patients with SII > 1800, SII was negatively correlated with OS (adjusted HR = 0.57; 95% CI 0.29-1.12; adjusted P = 0.102), however, there is no statistical difference. Interestingly, a high SS was associated with a poorer prognosis. The higher the SS score was, the worse the OS (P < 0.001). SII is an independent prognostic indicator of GC, and high SII is related to poor prognosis. A higher SS score had worse survival. Thus, the prognostic SS is a reliable predictor of OS in patients with GC.

The role of platelet mass index in the prediction of preeclampsia full

To assess the possible roles of platelet indices including platelet mass index (PMI), platelet count (PC), mean platelet volume (MPV) and PC/MPV in prediction of preeclampsia. 190 pregnant women diagnosed with preeclampsia and 100 healthy uncomplicated control patients were included in this retrospective study. Age, gestational week, fetal weight, alanine transaminase (ALT), aspartate transaminase (AST), creatinine, blood urea nitrogen (BUN), complete blood count parameters and platelet indices were compared. ROC curve was applied to analyze the cut-off values of the significantly differing parameters for prediction of preeclampsia. Preeclamptic patients gave birth significantly earlier than the controls. In preeclamptic patients, the mean values of PC, PC / MPV and PMI were significantly lower than the control group. Although mean MPV values were lower in preeclampsia patients, the difference was not significant. The cut-off values of PC, PC/MPV and PMI were found to be 207,500, 18448.16 and 2411.75 with a-sensitivity/specificity of 45.3%/ 44.3%, 42.2%/ 42.6% and 44.1%/ 44.3%, respectively. Indices such as PC, PC / MPV and PMI changed significantly in preeclampsia. Although they have low sensitivity and specificity, these indices can be combined with other parameters and used in the prediction of preeclampsia.

The pretreatment platelet count predicts survival outcomes of diffuse large B-cell lymphoma: An analysis of 1007 patients in the rituximab era

BackgroundThe prognostic value of platelet count in diffuse large B-cell lymphoma (DLBCL) has not been extensively investigated. We aimed to examine the association of pretreatment platelet count with disease features, and further examine the prognostic significance of platelet count in DLBCL treated with the R−CHOP regimen. MethodsPatients with DLBCL diagnosed between Jan 1 st, 2005 and Dec 31 st, 2018 at Cancer Hospital, Chinese Academy of Medical Sciences were retrospectively analyzed. Propensity score matching (PSM) was used to balance confounding factors. ResultsA total of 1007 eligible patients who received frontline R−CHOP or R−CHOP-like regimens were included in this study. The optimal cutoff value of platelet count was 157 × 109/L, as determined by the Maximally Selected Rank Statistics method. Patients with the platelet count ≤157 × 109/L had significantly inferior overall survival (OS) (5-year OS, 44.4 % vs. 74.9 %, P < 0.001) and progression-free survival (PFS) (5-year PFS, 35.5 % vs. 65.9 %, P < 0.001) than those with the platelet count >157×109/L. Multivariate analyses showed that pretreatment platelet count ≤ 157 × 109/L was an adversely independent prognostic factor for OS (hazard ratio [HR] 1.960, 95 % confidence interval [CI] 1.418−2.709, P<0.001) and PFS (HR 1.443, 95 %CI 1.080−1.927, P = 0.013). The PSM analysis and subgroup analyses further confirmed the significantly negative impact of low platelet count on OS and PFS. ConclusionThe pretreatment platelet count may be a simple, cost-effective and useful prognostic factor in DLBCL patients treated with frontline R−CHOP regimens. Further investigation is warranted to elucidate the biologic mechanism underlying the prognostic significance of platelet count in DLBCL.

Prognostic Impact of Increased Perioperative Platelet Count in Gastric Cancer Patients

BackgroundSolid tumors are a common cause of secondary (reactive) thrombocytosis, a paraneoplastic syndrome that is also a prognostic factor for various cancers. However, cutoff values for platelet count specific to gastric cancer and their prognostic roles are unknown. MethodsWe retrospectively analyzed records of 4643 patients with gastric cancer who underwent radical surgery from 2007 to 2010. The minimum P-value approach was used with the log-rank test to determine the optimal prognosis predicting threshold for preoperative platelet count. Change in perioperative platelet count over time was evaluated with a generalized estimating equation. Clinicopathologic features and prognostic significance were analyzed according to platelet count. ResultsThrombocytosis prevalence (platelet count ≥40 × 104/μL) was 1.6% (75 of 4643 patients). The platelet count cutoff value with the lowest P-value was ≥25.5 × 104/μL, and patients with higher platelet count had more advanced disease. Multivariate analysis showed that cutoff value was an independent prognostic factor of overall survival (hazard ratio 1.19, 95% confidence interval 1.03-1.37, P = 0.017). Patients who underwent adjuvant chemotherapy (n = 1300) and had a greater than 10% increase in platelet count at postoperative 1 y compared to before surgery had significantly poorer overall survival (hazard ratio 1.65, 95% confidence interval 1.11-2.45, P = 0.013). ConclusionsElevated preoperative platelet count (≥25.5 × 104/μL) and increased platelet count (≥10%) at postoperative 1 y in an adjuvant chemotherapy group were unfavorable prognostic factors. Platelet count could be a cost-effective biomarker for screening and monitoring patients with unfavorable survival outcomes.

Elevated platelet count is a negative predictive and prognostic marker in locally advanced rectal cancer undergoing neoadjuvant chemoradiation: a retrospective multi-institutional study on 965 patients

BackgroundIn patients with locally advanced rectal cancer treated by neoadjuvant chemoradiation, pathological complete response in the surgical specimen is associated with favourable long-term oncologic outcome. Based on this observation, nonoperative management is being explored in the subset of patients with clinical complete response. Whereas, patients with poor response have a high risk of local and distant recurrence, and appear to receive no benefit from standard neoadjuvant chemoradiation. Therefore, in order to develop alternative treatment strategies for non responding patients, predictive and prognostic factors are highly needed. Accumulating clinical observations indicate that elevated platelet count is associated with poor outcome in different type of tumors. In this study we investigated the predictive and prognostic impact of elevated platelet count on pathological response and long-term oncologic outcome in patients with locally advanced rectal cancer undergoing neoadjuvant chemoradiation.MethodsA total of 965 patients were selected from prospectively maintained databases of seven Centers within the SICO Colorectal Cancer Network. Patients were divided into two groups based on a pre-neoadjuvant chemoradiation platelet count cut-off value of 300 × 109/L identified by receiver operating characteristic curve considering complete pathological response as the outcome.ResultsComplete pathological response rate was lower in patients with elevated platelet count (12.8% vs. 22.1%, p = 0.001). Mean follow-up was 50.1 months. Comparing patients with elevated platelet count with patients with not elevated platelet count, 5-year overall survival was 69.5% vs.76.5% (p = 0.016), and 5-year disease free survival was 63.0% vs. 68.9% (p = 0.019). Local recurrence rate was higher in patients with elevated platelet count (11.1% vs. 5.3%, p = 0.001), as higher was the occurrence of distant metastasis (23.9% vs. 16.4%, p = 0.007). At multivariate analysis of potential prognostic factors EPC was independently associated with worse overall survival (HR 1.40, 95% CI 1.06–1.86), and disease free survival (HR 1.37, 95% CI 1.07–1.76).ConclusionsIn locally advanced rectal cancer elevated platelet count before neoadjuvant chemoradiation is a negative predictive and prognostic factor which might help to identify subsets of patients with more aggressive tumors to be proposed for alternative therapeutic strategies.

Neonates born to mothers with immune thrombocytopenia: 11 years experience of a single academic center.

: A major problem associated with immune thrombocytopenic purpura (ITP) in pregnancy is neonatal thrombocytopenia. We analyzed newborns born to mothers with ITP and examined predictive factors for thrombocytopenia. This retrospective study was performed in a single academic center from January 2007 to January 2018. Pregnant women with ITP and their babies are included. All neonates had a complete blood count and cranial ultrasound (USG) performed. Twenty seven neonates of 22 mothers were evaluated. A total of 23 (85%) of neonates were thrombocytopenic (<150 × 10/l) and in 20 (74%) platelet count was below 50 × 10/l. Median platelet count was 30 (4-300) × 10/l. One baby experienced intracranial hemorrhage, eight (29.6%) had minor bleeding. When babies with and without minor bleeding were compared; no significant difference was found regarding maternal age, duration of ITP, lowest and 'before delivery' platelet count, treatment during pregnancy and splenectomy. Cutoff value of platelet count for bleeding was calculated as 27 × 10/l with a sensitivity of 0.88 and specifity of 0.79. Strong correlation for postnatal thrombocytopenia was detected among siblings. Although the incidence of neonatal thrombocytopenia might be high, the incidence of poor neonatal outcomes is extremely low. Neonatal thrombocytopenia does not rely on maternal profile. The occurrence of neonatal thrombocytopenia and bleeding may be a risk factor for subsequent pregnancies. We suggest that the cutoff value for neonatal platelet count for bleeding can be used for management and treatment of neonates born to mothers with ITP.

Correlation of thrombocytopenia with grading of esophageal varices in chronic liver disease patients

Objective The aim of this study was to determine the correlation of thrombocytopenia with esophageal variceal grading in chronic liver disease patients. Background Esophageal varices (EVs) are a serious consequence of portal hypertension in patients with chronic liver disease. Several studies have evaluated possible noninvasive predictors for the presence and size of varices, including platelet count. Materials and methods This study included 210 patients who presented with chronic liver disease in Menouf Fever Hospital. The diagnosis was based on history, clinical, laboratory, and imaging data. They were divided into two groups: group I and group II. Group I included 140 patients with EVs and was subdivided into group IA, which included 60 patients with grade I, group IB, which included 40 patients with grade II, and group IC, which included 40 patients with grade III, and group II included 70 patients without EVs. Correlation of thrombocytopenia with the grading of EVs was assessed using Spearman's correlation. Results Platelet count was significantly lower in patients with EV grades I, II, and III (mean ± SD; 100.5 ± 19.8, 65.2 ± 13.0, and 60.3 ± 14.1 × 103/mm3, respectively) than in those without EVs (152.1 ± 17.1 × 103/mm3). Moreover, it was significantly lower in patients with grades II and III (large EVs) (65.2 ± 13.0 and 60.3 ± 14.1 × 103/mm3, respectively) than in patients with grade I (small EVs) (100.5 ± 19.8 × 103/mm3) (P Conclusion Thrombocytopenia is a good noninvasive predictor for the presence and size of EVs in chronic liver disease patients. There was a significant negative correlation between platelet count and grading of EVs.

The combination of platelet count and neutrophil to lymphocyte ratio (COP-NLR) for prediction of treatment outcome for patients with localized renal cell carcinoma.

598 Background: The combination of platelet count and neutrophil to lymphocyte ratio (COP-NLR) has been shown to provide prognostic information in several cancers. The object of the present study was to examine the preoperative prognostic value of the COP-NLR in localized RCC. Methods: The records of 268 patients were analyzed in the study. The cut-off value of platelet count and NLR were defined by receive operating characteristic (ROC) analysis and the areas under the curve (AUC). Patients with both an increased platelet count ( &gt; 31.0×104 mm-3) and an elevated NLR ( &gt; 3.85) were assigned a score of 2, and patients with one or neither were assigned as a score of 1 or 0, respectively. Results: There were 198, 63, and 7 patients assigned to the COP-NLR of 0, 1, and 2, respectively. Five year OS rates were 93.8% in COP-NLR0, 72.2% in COP-NLR1 and 0% in COP-NLR 2, demonstrating a significant difference in their prognosis among the COP-NLR in localized RCC patients. Multivariate analysis using the 10 clinicopathological findings selected by univariate analyses demonstrated that the preoperative COP-NLR was an independent prognostic factor for OS (HR: 2.32, 95%CI: 1.22 to 4.26, p = 0.011) and RFS (HR: 1.91, 95%CI: 1.02 to 3.53, p = 0.044). Conclusions: The preoperative COP-NLR is an independent prognostic indicator of OS and RFS for patients with localized RCC. [Table: see text]

The combination of preoperative platelet count and neutrophil lymphocyte ratio as a prognostic indicator in localized renal cell carcinoma.

IntroductionThe combination of platelet count and neutrophil to lymphocyte ratio (COP-NLR) has been shown to provide prognostic information in several cancers, whereas its prognostic value in renal cell carcinoma (RCC) has not been reported. The objective of the present study was to examine the preoperative prognostic value of the COP-NLR in patients with localized RCC undergoing nephrectomy.Material and MethodsThe record of 268 patients, who underwent nephrectomy due to a diagnosis of RCC at our institute was analyzed in the study. The cut-off value of platelet count and NLR were defined by receive operating characteristic (ROC) analysis and the areas under the curve (AUC). Patients with both an increased platelet count (> 310×109/l) and an elevated NLR (> 3.85) were assigned to the score 2, and patients with one or neither of these indicators were assigned to the score 1 or 0, respectively. The impact of the COP-NLR and other clinicopathological characteristics on overall survival (OS) and recurrence-free survival (RFS) were evaluated using the univariate and multivariate Cox regression analysis.ResultThe median follow-up duration after surgical resection was 60 months. Multivariate analysis using the 10 clinicopathological findings selected by univariate analyses demonstrated that the preoperative COP-NLR was an independent prognostic factor for OS (HR: 2.32, 95%CI: 1.22 to 4.26, p=0.011) and RFS (HR: 1.91, 95%CI: 1.02 to 3.53, p=0.044).ConclusionThe findings of the current study suggested that the preoperative COP-NLR is an independent prognostic indicator of OS and RFS for patients with localized RCC.

Correlation of platelets count with endoscopic findings in a cohort of Egyptian patients with liver cirrhosis.

Screening endoscopy is recommended for early detection of esophageal varices (EVs) in cirrhotic patients with portal hypertension. However, this approach is limited by its invasiveness and cost. The aim of the study was to determine if platelet count can predict the presence of EVs, especially large (grade III, IV) EVs in need of prophylactic therapy, in a cohort of Egyptian patients with liver cirrhosis. In all, 110 patients with cirrhosis were prospectively analyzed. The presence of medium or large EVs was correlated with patients’ platelet count and FIB-4. Esophageal varices were present in 87 (79.09%) patients. Among those with thrombocytopenia (platelet level below 150,000), 25.97% (20 patients) and 27.27% (21 patients) had EV grade II and EV grade III or IV, respectively. Whereas in patients in whom the platelet count was above 150,000, only 21.21% (7 patients) and 9.09% (3 patients) of patients had grade II EV and EV grade III or IV, respectively. A platelet count cut-off value of 149,000 was found to have specificity of 82% and sensitivity 39% for detection of presence of varices. A FIB-4 cut-off value of 3.175 was found to have an 83.3% sensitivity and 39.5% specificity in detecting large (grade III, IV) EVs. Platelet count is a noninvasive parameter with high accuracy for prediction of EVs. Cirrhotic patients with normal platelet counts (above 150,000), especially in financially deprived developing countries, can avoid screening endoscopy as they are at a low risk for variceal bleeding, and presence of large EVs in these patients is much less common than in those with thrombocytopenia. A 3.175 cut-off value of FIB-4 could be useful as a noninvasive predictor of large varices requiring prophylactic banding in cirrhotic patients.

Can Platelet Count and Platelet Indices Predict the Risk and the Prognosis of Preeclampsia?

Objective: To compare the hematocrit, platelet count (PC), mean platelet volume (MPV), platelet distribution width (PDW), PC to MPV ratio in the mild preeclamptic (mPE), severe preeclamptic (sPE) and healthy normotensive pregnant women to evaluate whether these parameters have a predictive and prognostic significance in determining the risk and the severity of preeclampsia (PE). Methods: A retrospective case-control study was designed including the patient population (N = 284) composed of 49 mPE, 70 sPE, 165 healthy normotensive pregnant women for controls. Preceding medical histories of all the cases were insignificant. Results: In comparison of the preeclamptic patients with controls; there was statistically significant difference in PC (p = 0.023; p < 0.05), MPV(p = 0.023; p < 0.05), PC/MPV ratio (p = 0.005; p < 0.01). But there was no difference between sPE and mPE. Cut-off value for MPV was calculated as 9 for the diagnosis of PE (p < 0.01), the odds ratio was 1.999. The cut off value for PC was 190, the odds ratio was 1.932. The cut off value was 19.9 for the PLT/MPV, the odds ratio was 2.42. Conclusion: We suggest that the increasing platelet turnover in PE causes a decrease in the PC, an increase of MPV value and especially a decrease in PC/MPV ratio pointing that these parameters may play an important role in predicting the risk of PE while they have no role on predicting the severity of PE. According to our findings we can suggest that the patients with these cut-off values of PC and platelet indices, should be carefully followed for the development of PE.

Association between platelet count as a noninvasive marker and ultrasonographic grading in patients with nonalcoholic Fatty liver disease.

Background:Nonalcoholic fatty liver disease has become a worldwide challenge. Liver biopsy remains the single most reliable approach to determine the severity of this disease. As patients with nonalcoholic fatty liver disease require close follow-up, performing this invasive method repeatedly seems impractical; therefore, designing a noninvasive system to follow up patients has become a common interest.Objectives:We intended to investigate the association between platelet counts of patients with nonalcoholic fatty liver disease and the severity of their disease based on serum levels of liver enzymes and grade of fatty liver on ultrasonography.Patients and Methods:One thousand, three hundred and five patients with nonalcoholic fatty liver disease were included in this descriptive study. Serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP) and platelet counts of patients were measured. The grade of fatty liver was determined by abdominal ultrasonography.Results:Of our study population, 54.3% (n = 708) were women. Patients with mild fatty liver on ultrasonography had lower platelet counts than those with moderate and severe fatty liver. However, no cutoff value of platelet count could reliably distinguish different grades of fatty liver. We found no significant association between platelet counts and serum levels of AST, ALT or ALP. However, we showed that male patients with abnormal levels of ALT had higher platelet counts.Conclusions:Platelet count in nonalcoholic fatty liver disease can serve as a clue to the severity of disease, but it cannot be considered as a sole test to follow up patients.

Simple scoring system for predicting cirrhosis in nonalcoholic fatty liver disease.

To investigate a simple noninvasive scoring system for predicting liver cirrhosis in nonalcoholic fatty liver disease (NAFLD) patients. A total of 1048 patients with liver-biopsy-confirmed NAFLD were enrolled from nine hepatology centers in Japan (stage 0, 216; stage 1, 334; stage 2, 270; stage 3, 190; stage 4, 38). The weight and height of the patients were measured using a calibrated scale after requesting the patients to remove their shoes and any heavy clothing. Venous blood samples were obtained in the morning after the patients had fasted overnight for 12 h. Laboratory evaluation was performed in all patients. Statistical analysis was conducted using SPSS version 12.0. Continuous variables were expressed as mean ± SD. The optimal cutoff value of platelet count, serum albumin, and aminotransferase/alanine aminotransferase ratio (AAR) was set at < 15.3 10(4)/μL, < 4.0 g/dL, and > 0.9, respectively, by the receiver operating characteristic curve. These three variables were combined in an unweighted sum (platelet count = 1 point, serum albumin = 1 point, AAR = 1 point) to form an easily calculated composite score for predicting cirrhosis in NAFLD patients, called the PLALA (platelet, albumin, AAR) score. The diagnosis of PLALA ≥ 2 had sufficient accuracy for detecting liver cirrhosis in NAFLD patients. The PLALA score may be an ideal scoring system for detecting cirrhosis in NAFLD patients with sufficient accuracy and simplicity to be considered for clinical use.

Therapeutic rather than prophylactic platelet transfusion policy for severe thrombocytopenia during liver transplantation

Platelet transfusion (PTx) has been identified as an important risk factor for morbidity and mortality after liver transplantation (LTx). Our aim was to evaluate the safety of therapeutic rather than prophylactic PTx policy in severe thrombocytopenic patients undergoing LTx. Recipients of LTx were divided into two groups: group I (GI) (n = 76) platelet count (PC) ≥ 50 × 109/l and group II (GII) PC < 50 × 109/l (n = 76). Platelets were transfused following a thromboelastometry protocol and clinical signs of diffuse bleeding. Both groups were compared regarding hemoglobin (Hb), international normalized ratio (INR), fibrinogen level, blood loss (BL), blood products required, percentage of bloodless surgery, duration of mechanical ventilation, ICU stay, and vascular complications. Each group was further subdivided according to PTx into (GI NPTx and GII NPTx) with no platelet transfusion (NPTx) and (GI PTx and GII PTx) received PTx. These subgroups were further compared for some variables. Base line Hb was significantly higher while INR was significantly lower in GI.75% avoided PTx in GII. Comparisons of BL, packed red blood cells (PRBCs), and cryoprecipitate transfusion were insignificant. Fresh frozen plasma (FFP) transfusion was higher and the percentage of bloodless surgery was lower in GII. In GII, PC increased after start of surgery. Two cases of hepatic artery thrombosis in GI and one in GII were recorded. Recovery of platelets was quicker, and duration of mechanical ventilation and ICU stay was shorter in NPTx patients regardless the base line PC. Cut-off values of PC 30 × 109/l (with sensitivity 73.7% and specificity 78.8%, p < 0.01), BL of 3750 ml in GI (sensitivity of 75% and specificity of 69%, p < 0.01) and of 3250 ml in GII (sensitivity of 84.2% and specificity of 87.7% (p < 0.01)) could indicate the need of PTx. With therapeutic approach, 75% of patients in GII could avoid unnecessary PTx with its hazards without excessive bleeding. PC in GII increased intraoperatively, PTx may lead to delayed recovery of platelets, increased duration of mechanical ventilation and ICU stay. The given cut-off values may help to guide PTx.

Intraaortic Balloon Pump: Incidence and Predictors of Complications in the Florence Registry

The intraaortic balloon pump (IABP) is the most commonly used mechanical circulatory support for patients with acute coronary syndromes and cardiogenic shock. Nevertheless, IABP-related complications are still frequent and associated with a poor prognosis. To prospectively assess the incidence and predictors of complications in patients treated with IABP. A total of 481 patients treated with IABP were prospectively enrolled in our registry (the Florence Registry). At multivariable logistic regression analysis the following variables were independent predictors for complications (when adjusted for age >75 years, eGFR and time length of IABP support): use of inotropes (OR 2.450, P < 0.017), nadir platelet count (1000/µL step; OR 0.990, P < 0.001), admission lactate (OR 1.175, P = 0.003). Nadir platelet count showed a negative correlation with length of time of IABP implantation (r-0.31; P < 0.001). A nadir platelet count cutoff value of less than 120,000 was identified using a receiver operating characteristic (ROC) curve for the development of complications (area under the curve [AUC] 0.70; P < 0.001). Complications were observed in the 13.1%, among whom 33 of 63 showed major bleeding. The incidence of complications was higher in patients aged >75 years (P = 0.015) and in those who had an IABP implanted for more than 24 hours (P = 0.001). Patients with complications showed an in Intensive Cardiac Care Unit (ICCU) mortality higher than patients who did not (44.4% vs 17.2%, P < 0.001). In consecutive patients treated with IABP support, the degree of hemodynamic impairment and the decrease in platelet count were independent predictors of complications, whose development was associated with higher in-ICCU mortality.

Platelet count for predicting fibrosis in nonalcoholic fatty liver disease

The severity of liver fibrosis is known to be a good indicator for surveillance, and for determining the prognosis and optimal treatment of nonalcoholic fatty liver disease (NAFLD). However, it is virtually impossible to carry out liver biopsies in all NAFLD patients. The purpose of this study was to investigate the clinical usefulness of measuring the platelet count for predicting the severity of liver fibrosis in a large retrospective cohort of Japanese patients with NAFLD. A total of 1,048 patients with liver-biopsy-confirmed NAFLD seen between 2002 and 2008 were enrolled from nine hepatology centers in Japan. Laboratory evaluations were performed for all patients. A linear decrease of the platelet count with increasing histological severity of hepatic fibrosis was revealed. The area under the receiver operating characteristic curve estimating the diagnostic performance of the platelet count for hepatic fibrosis Stage 3 was 0.774 (optimal cutoff value, 19.2 × 10(4)/μl; sensitivity, 62.7%; specificity, 76.3%), and that for Stage 4 was 0.918 (optimal cutoff value, 15.3 × 10(4)/μl; sensitivity, 80.5%; specificity, 88.8%). The platelet count may be an ideal biomarker of the severity of fibrosis in NAFLD patients, because it is simple, easy to measure and handle, cost-effective, and accurate for predicting the severity of fibrosis. Furthermore, by using the platelet count cutoff value validated in our multiple large trials, efficient recruitment of NAFLD patients may be facilitated.