ORIGINAL ARTICLES—LIVER, PANCREAS, AND BILIARY TRACT Incidence, Prevalence, and Clinical Significance of Abnormal Hematologic Indices in Compensated Cirrhosis

Background & Aims: 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, <13.5 g/dL for men and 11.5 g/dL for women), leukopenia (white blood cell counts, <4000/mm 3 ), or thrombocytopenia (platelet counts, <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.