The platelet count as a predictor of variceal hemorrhage in primary biliary cirrhosis.
BACKGROUND
Variceal bleeding is a common, life-threatening complication of primary biliary cirrhosis (PBC) that remains difficult to predict.


OBJECTIVE
The aim of this study was to identify whether certain biochemical and hematological parameters may be used as predictors of variceal bleeding in patients with PBC.


METHODS
Cox proportional hazard regression analysis was used to test whether various prognostic factors were significantly associated with the time of first bleeding in 63 patients with proven PBC, of whom 11 had subsequent bleeding.


RESULTS
Both the first available platelet count and the bilirubin level were of significant value in predicting variceal bleeding, but only the platelet count was an independent predictor of bleeding. In the group of patients who subsequently bled, there was a progressive drop in the platelet count over the follow-up period, with a proportional increase in the risk of bleeding; a platelet count below 200 x 10(9)/L was strongly associated with variceal bleeding (p < 0.001). None of the patients with platelet count above 200 x 10(9)/L bled over a total of 136 patient-years follow-up. In the group who did not bleed, no change in platelet count was identified during follow up.


CONCLUSIONS
We conclude that the platelet count can be used as a predictor of variceal bleeding in PBC.
Plevris
J N
JN
Department of Medicine, University of Edinburgh, Scotland.
Dhariwal
A
A
Elton
R A
RA
Finlayson
N D
ND
Bouchier
I A
IA
Hayes
P C
PC
D000368:Aged; D001663:Bilirubin / Q000097:blood; D004932:Esophageal and Gastric Varices / Q000150:complications*; D006471:Gastrointestinal Hemorrhage / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000150:complications*; D008875:Middle Aged; D010976:Platelet Count; D011379:Prognosis; D012044:Regression Analysis; D012307:Risk Factors
D001663:Bilirubin