title: Determinants of platelet count are different in patients with compensated and decompensated cirrhosis.
abstract: OBJECTIVE
  Different mechanisms including portal hypertension and hypersplenism have been involved in the development of thrombocytopenia in cirrhosis. However, the relative contribution of each one is unknown. The aim was to evaluate simultaneously different mechanisms that determine platelet count in cirrhosis.
  
  
  METHODS
  Cross-sectional study including cirrhotics (n = 120) with hepatic venous pressure gradient (HVPG) measurement. Samples were obtained from peripheral (P) veins to evaluate thrombopoietin (TPO), stem cell factor, hepatocyte growth factor (HGF), tumour necrosis factor, interleukin-(IL6) and (IL11) and from hepatic (H) veins to evaluate TPO. A subgroup (n = 72) had spleen volume estimation. H and P-TPO were also measured in non-cirrhotic patients (n = 15).
  
  
  RESULTS
  Patients (Child A: 55, B: 43, C: 22) had a median platelet count of 81 000/mm(3) (IQR 60 500, 110 750), which correlated with spleen volume (r = -0.38, P < 0.001). Platelets were associated also to HVPG (r = -0.47, P = 0.004) and P-TPO (r = 0.31, P = 0.050) only in compensated patients. H-TPO decreased, and the proportion of patients with P-TPO > H-TPO increased, with the presence and the severity of liver disease. H-TPO was correlated with liver function (bilirubin r = -0.350, P < 0.001 and international normalized ratio r = -0.227, P = 0.011). Patients with H-TPO < P-TPO had higher levels of IL-11 and HGF.
  
  
  CONCLUSIONS
  Platelet count in cirrhosis is associated mainly to spleen volume, although portal hypertension as estimated by HVPG and liver function plays a significant role in compensated patients. H-TPO and the proportion of patients with P-TPO > H-TPO were associated to the presence and severity of liver disease.
authors.affiliation: Department of Digestive Diseases, Liver Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain.|CIBERehd, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Latorre
authors.affiliation: Department of Digestive Diseases, Liver Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain.|CIBERehd, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Vaquero
authors.affiliation: Department of Digestive Diseases, Liver Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain.|CIBERehd, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Diego
authors.initials: D
authors.lastname: Rincón
authors.affiliation: Department of Digestive Diseases, Liver Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain.|CIBERehd, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Puerto
authors.affiliation: Department of Radiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: María D
authors.initials: MD
authors.lastname: Ponce
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Sarnago
authors.affiliation: Department of Digestive Diseases, Liver Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Jose A
authors.initials: JA
authors.lastname: Matamoros
authors.affiliation: Department of Radiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Ramón
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Jaime
authors.initials: J
authors.lastname: Elizaga
authors.affiliation: Department of Digestive Diseases, Liver Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain.|CIBERehd, Hospital General Universitario Gregorio Marañón, Madrid, Spain.|Facultad de Medicina, Universidad Complutense Madrid Spain, Madrid, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Bañares
authors.affiliation: Department of Digestive Diseases, Liver Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain.|CIBERehd, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Ripoll
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006971:Hypersplenism / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D006975:Hypertension, Portal / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D019934:International Normalized Ratio; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications / Q000175:diagnosis; D008111:Liver Function Tests / Q000379:methods; D008297:Male; D008875:Middle Aged; D062072:Patient Acuity; D010976:Platelet Count / Q000379:methods; D012720:Severity of Illness Index; D013154:Spleen / Q000473:pathology*; D013223:Statistics as Topic; D013921:Thrombocytopenia / Q000097:blood / Q000175:diagnosis / Q000209:etiology
keywords: end-stage liver disease; liver insufficiency; pathophysiology; portal hypertension; thrombocytes