Thrombocytopenia in cirrhosis: Impact of fibrinogen on bleeding risk

Table 1 Baseline demographics for patients with chronic liver disease who have undergone orthotopic liver transplantation¹

	Excessive transfusion	No excessive transfusion	Total	P value
n	114 (46.3%)	132 (53.7%)	246
Age (yr)
Mean	53.12	52.72	52.91	0.757
SD	9.68	10.38	10.04
Gender
Female	28 (24.6%)	39 (29.5%)	67 (27.2%)	0.381
Male	86 (75.4%)	93 (70.5%)	179 (72.8%)
UKELD
Mean	56.11	51.11	53.02	< 0.001
SD	10.55	5.08	6.22
Diagnosis
ALD	44 (38.6%)	29 (21.9%)	73 (29.6%)
Infectious	40 (35.1%)	42 (31.8%)	82 (33.3%)
NASH	4 (3.5%)	6 (4.5%)	10 (4.1%)
PSC	9 (7.9%)	25 (18.9%)	34 (13.8%)
PBC	3 (2.6%)	6 (4.5%)	9 (3.7%)
AIH	4 (3.5%)	3 (2.3%)	7 (2.8%)
Wilsons	1 (0.8%)	0 (0%)	1 (0.4%)
Haemochromatosis	1 (0.8%)	0 (0%)	1 (0.4%)
Misc	8 (7.0%)	21 (15.9%)	29 (11.8%)
Hb (g/L)
Mean	101.90	109.71	106.09	< 0.001
SD	16.89	15.38	16.53
Platelets (× 109/L)
Mean	83.18	107.29	96.12	0.005
SD	55.03	75.14	67.53
Median	67	84.5	76.0
IQR	42.5	77.5	61.25
Fibrinogen (g/L)
Mean	1.96	2.60	2.3	0.004
SD	0.91	1.15	1.09
Hep MA (mm)
Mean	42.15	47.71	45.14	0.001
SD	12.68	11.87	12.54
Total blood returned (mL)
Mean	3323	487	1802
SD	2536	419	2251

¹Excessive transfusion defined as blood volume returned > 1200 mL. SD: Standard deviation; UKELD: United Kingdom end stage liver disease score; ALD: Alcoholic liver disease; NASH: Non-alcoholic steato-hepatitis; PSC: Primary sclerosing cholangitis; PBC: Primary biliary cirrhosis; AIH: Autoimmune hepatitis; Hb: Haemoglobin; Hep MA: Maximum amplitude on heparinase thromboelastography.

Table 2 Comparison of baseline demographics according to baseline platelet count cut off value of 50 × 10⁹/L

	Platelet count < 50	Platelet count ≥ 50	P value
n	53 (21.5%)	193 (78.5%)
Age (yr)
Mean	51.23	53.37	0.13
SD	10	9.04
Median	52.38	55.26
Range	52	50
Gender
Female	40 (75.5%)	139 (72%)	0.62
Male	13 (24.5%)	54 (28%)
UKELD
Mean	54.16	52.72	0.09
SD	5.06	6.47
Diagnosis
ALD	10 (19%)	63 (33%)
Infectious	30 (56%)	52 (27%)
NASH	3 (6%)	7 (4%)
PSC	5 (9%)	29 (15%)
PBC	1 (2%)	8 (4%)
AIH	2 (4%)	5 (2%)
Wilsons	0	1 (0.5%)
Haemochromatosis	0	1 (0.5%)
Misc	2 (4%)	27 (14%)
Hb (g/L)
Mean	106.34	106.03	0.89
SD	15.08	16.94
Fibrinogen (g/L)
Mean	1.78	2.45	< 0.001
SD	0.62	1.15
Hep MA (mm)
Mean	35.28	47.85	< 0.001
SD	9.49	11.93
Total blood returned (mL)
Mean	1692.13	1831.6	0.69
SD	1426.72	2431.54
Median	1500	1110
Range	6305	21237

SD: Standard deviation; UKELD: United Kingdom end stage liver disease score; ALD: Alcoholic liver disease; NASH: Non-alcoholic steato-hepatitis; PSC: Primary sclerosing cholangitis; PBC: Primary biliary cirrhosis; AIH: Autoimmune hepatitis; Hb: Haemoglobin; Hep MA: Maximum amplitude on heparinase thromboelastography.

Table 3 Univariate logistic regression

	Odds ratio	95%CI	P value
Age	1.004	0.979-1.029	0.76
Gender	1.288	0.730-2.271	0.382
UKELD	1.130	1.076-1.188	< 0.001
Hb	0.97	0.954-0.986	< 0.001
Platelet count	0.994	0.990-0.998	0.007
Platelets (Binary cut off < 50 and ≥ 50)	1.393	0.758-2.563	0.286
Fibrinogen	0.523	0.388-0.703	< 0.001
Hep MA	0.963	0.942-0.984	0.001

UKELD: United Kingdom end-stage liver disease score; Hb: Haemoglobin; Hep MA: Maximum amplitude on heparinise TEG.

Table 4 Multivariate logistic regression with covariates P < 0.1 from univariate logistic regression

	OR	95%CI	P value
UKELD	1.081	1.023-1.143	0.006
Hb	0.977	0.958-0.997	0.022
Platelets	0.999	0.994-1.004	0.700
Fibrinogen	0.682	0.487-0.955	0.026
Hep MA	0.986	0.957-1.015	0.338

OR: Odds ratio; UKELD: United Kingdom end-stage liver disease score; Hb: Haemoglobin; Hep MA: Maximum amplitude on heparinise TEG.

Table 5 Relationship between baseline platelet count and baseline fibrinogen and blood returned to patients (linear regression)

Model	Regression coefficient B	95%CI	P value
Platelet count	2280.72-4.99	-9.142-0.829	< 0.001
Fibrinogen	3014.63-525.95	-776.88-275.02	< 0.001