ABSTRACT
Background and Objectives
Hypersplenism is frequently seen in patients with cirrhosis. However, it is unclear
why some patients with cirrhosis develop marked hypersplenism and others do not. Additionally,
the implications of severe hypersplenism are unknown. Therefore, we conducted a study
to evaluate the predictors and implications of severe hypersplenism in patients with
cirrhosis.
Subjects and Methods
All subjects with cirrhosis who were referred to Indiana University over a 53-month
period for liver transplantation were studied. Severe hypersplenism was defined as
platelet count<75,000 per mm3 and/or white blood cell count<2,000 per mm3 in the presence of splenomegaly. The outcomes of interest were development of spontaneous
bacterial peritonitis (SBP), variceal bleeding, and death. Patients were observed
until death, transplantation, or study closure.
Results
The study group comprised 329 subjects with cirrhosis and their median follow-up time
was 450 days (0.25–42 months). The prevalence of severe hypersplenism was 33%. Decompensated liver disease
[odds ratio (OR), 2.0; 95% confidence interval (CI), 1.1–3.7] and a history of alcohol
consumption (OR 2.3; 95% CI, 1.4–3.8) were independent predictors of severe hypersplenism.
The presence of severe hypersplenism independently predicted the development of variceal
bleeding [hazard ratio (HR) 4.1; 95% CI, 1.7–10], SBP (HR 8.0; 95% CI, 3.1–20.5),
and death (HR 2.0; 95% CI 1.2–3.4).
Conclusions
This study suggests that severe hypersplenism is an independent risk factor for developing
variceal bleeding, SBP, and death in patients with cirrhosis. If these observations
are confirmed, severe hypersplenism can be considered as an indication for prophylactic
measures against variceal bleeding and SBP.
KEY INDEXING TERMS
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Article info
Publication history
Accepted:
June 20,
2003
Received:
April 17,
2003
Identification
Copyright
© 2003 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
