title: Incidence, prevalence, and clinical significance of abnormal hematologic indices in compensated cirrhosis.
abstract: OBJECTIVE
  Patients with cirrhosis develop abnormal hematologic indices (HI) from multiple factors, including hypersplenism. We aimed to analyze the sequence of events and determine whether abnormal HI has prognostic significance.
  
  
  METHODS
  We analyzed a database of 213 subjects with compensated cirrhosis without esophageal varices. Subjects were followed for approximately 9 years until the development of varices or variceal bleeding or completion of the study; 84 subjects developed varices. Abnormal HI was defined as anemia at baseline (hemoglobin, < or =13.5 g/dL for men and 11.5 g/dL for women), leukopenia (white blood cell counts, < or =4000/mm3), or thrombocytopenia (platelet counts, < or =150,000/mm3). The primary end points were death or transplant surgery.
  
  
  RESULTS
  Most subjects had thrombocytopenia at baseline. Kaplan-Meier analysis showed that leukopenia occurred by 30 months (95% confidence interval, 18.5-53.6), and anemia occurred by 39.6 months (95% confidence interval, 24.1-49.9). Baseline thrombocytopenia (P = .0191) and leukopenia (P = .0383) were predictors of death or transplant, after adjusting for baseline hepatic venous pressure gradient (HVPG), and Child-Pugh scores. After a median of 5 years, a significant difference in death or transplant, mortality, and clinical decompensation was observed in patients who had leukopenia combined with thrombocytopenia at baseline compared with patients with normal HI (P < .0001). HVPG correlated with hemoglobin and white blood cell count (hemoglobin, r = -0.35, P < .0001; white blood cell count, r = -0.31, P < .0001).
  
  
  CONCLUSIONS
  Thrombocytopenia is the most common and first abnormal HI to occur in patients with cirrhosis, followed by leukopenia and anemia. A combination of leukopenia and thrombocytopenia at baseline predicted increased morbidity and mortality.
authors.affiliation: Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts 02115, USA.aqamar@partners.org
authors.forename: Amir A
authors.initials: AA
authors.lastname: Qamar
authors.forename: Norman D
authors.initials: ND
authors.lastname: Grace
authors.forename: Roberto J
authors.initials: RJ
authors.lastname: Groszmann
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Garcia-Tsao
authors.forename: Jaime
authors.initials: J
authors.lastname: Bosch
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Burroughs
authors.forename: Cristina
authors.initials: C
authors.lastname: Ripoll
authors.forename: Rie
authors.initials: R
authors.lastname: Maurer
authors.forename: Ramon
authors.initials: R
authors.lastname: Planas
authors.forename: Angels
authors.initials: A
authors.lastname: Escorsell
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Garcia-Pagan
authors.forename: David
authors.initials: D
authors.lastname: Patch
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Matloff
authors.forename: Robert
authors.initials: R
authors.lastname: Makuch
authors.forename: Gabriel
authors.initials: G
authors.lastname: Rendon
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007970:Leukopenia; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D013921:Thrombocytopenia; D055815:Young Adult