The predictive role of platelet count for bleeding in patients with hepatitis B virus and hepatitis C virus infection

Cih En Huang, Jung Jung Chang, Chih Cheng Chen, Ying Hsuan Wang, Chang Hsien Lu, Yi Yang Chen, Ting Yao Wang, Min Chi Chen*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

Abstract

The impact of platelet count on bleeding in hepatitis B virus (HBV) and hepatitis C virus (HCV)-infected patients is unclear. We aimed to evaluate the relationship between platelet count and bleeding in patients with viral hepatitis.We selected patients with HBV and HCV infection. All esophagogastroduodenoscopy, colonoscopy, and brain imaging reports were reviewed to document upper gastrointestinal bleeding (UGIB), lower gastrointestinal bleeding (LGIB), and central nervous system bleeding (CNSB), respectively. We analyzed risk factors for first bleeding events by using Cox proportional hazards models. Incidence rate ratios (IRRs) were used to compare bleeding incidences between viral types and platelet levels.A total of 2522 HCV and 2405 HBV patients were enrolled. The HCV-To-HBV IRRs of UGIB, LGIB, and CNSB were significant at 1.797, 2.255, and 2.071, respectively. The common risk factors in both groups were thrombocytopenia, hypoalbuminemia, high alkaline phosphatase level, and cirrhosis for UGIB, whereas thrombocytopenia and hypoalbuminemia for LGIB. Hypoalbuminemia was the only risk for CNSB. After adjusting platelet count, the higher bleeding rates in the HCV patients diminished. Using a reference platelet count less than 100 x 109/l, bleeding risk elevated at platelet count less than 70 x 109/l and less than 40 x 109/l for UGIB and LGIB in the HCV patients, respectively, compared with less than 60 x 109/l for UGIB in the HBV patients. The incidence of CNSB was not related to platelet levels.HCV patients had a higher risk for major bleeding. Thrombocytopenia was a significant predictor. Monitoring and management of thrombocytopenia in addition to cirrhotic status was important in these patients.

Original languageEnglish
Pages (from-to)310-318
Number of pages9
JournalBlood Coagulation and Fibrinolysis
Volume34
Issue number5
DOIs
StatePublished - 01 07 2023
Externally publishedYes

Bibliographical note

Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

Keywords

  • albumin
  • bleeding
  • hepatitis B virus
  • hepatitis C virus
  • thrombocytopenia
  • Humans
  • Hepatitis C/complications
  • Gastrointestinal Hemorrhage/complications
  • Hypoalbuminemia/complications
  • Platelet Count
  • Hepatitis B/complications
  • Hepatitis B virus
  • Hepacivirus
  • Thrombocytopenia/complications

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