Adriaan J van der Meer1, Raoel Maan1, Bart J Veldt1, Jordan J Feld2, Heiner Wedemeyer3, Jean-François Dufour4, Frank Lammert5, Andres Duarte-Rojo6, Michael P Manns3, Stefan Zeuzem7, W Peter Hofmann7, Robert J de Knegt1, Bettina E Hansen1, Harry LA Janssen1,2. 1. Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands. 2. The Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada. 3. Department of Gastroenterology, Hepatology, and Endocrinology, Medical School Hannover, Hannover, Germany. 4. Hepatology, Department of Clinical research, University of Bern, Bern, Switzerland. 5. Department of Medicine II, Saarland University Medical Center, Homburg, Germany. 6. Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Arkansas, USA. 7. Medizinische Klinik 1, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main, Germany.
Abstract
BACKGROUND AND AIMS: Patients with chronic hepatitis C virus (HCV) infection may develop cirrhosis with portal hypertension, reflected by decreased platelet count and splenomegaly. This retrospective cohort study aimed to assess changes in platelet counts after antiviral therapy among chronic HCV-infected patients with advanced fibrosis. METHODS: Platelet counts and spleen sizes were recorded in an international cohort of patients with Ishak 4-6 fibrosis who started antiviral therapy between 1990 and 2003. Last measured platelet counts and spleen sizes were compared with their pre-treatment values (within 6 months prior to the start of therapy). All registered platelet count measurements from 24-week following cessation of antiviral therapy were included in repeated measurement analyses. RESULTS: This study included 464 patients; 353 (76%) had cirrhosis and 187 (40%) attained sustained virological response (SVR). Among patients with SVR, median platelet count, increased by 35 × 10(9) /L (IQR 7-62, P < 0.001). In comparison, patients without SVR showed a median decline of 17 × 10(9) /L (IQR -5-47, P < 0.001). In a subgroup of 209 patients, median decrease in spleen size was 1.0 cm (IQR 0.3-2.0) for patients with SVR, while median spleen size increased with 0.6 cm (IQR -0.1-2.0, P < 0.001) among those without SVR. The changes in spleen size and platelet count were significantly correlated (R = -0.41, P < 0.001). CONCLUSIONS: Among chronic HCV-infected patients with advanced hepatic fibrosis, the platelet counts improved following SVR and the change in platelets correlated with the change in spleen size following antiviral therapy. These results suggest that HCV eradication leads to reduced portal pressure.
BACKGROUND AND AIMS: Patients with chronic hepatitis C virus (HCV) infection may develop cirrhosis with portal hypertension, reflected by decreased platelet count and splenomegaly. This retrospective cohort study aimed to assess changes in platelet counts after antiviral therapy among chronic HCV-infectedpatients with advanced fibrosis. METHODS: Platelet counts and spleen sizes were recorded in an international cohort of patients with Ishak 4-6 fibrosis who started antiviral therapy between 1990 and 2003. Last measured platelet counts and spleen sizes were compared with their pre-treatment values (within 6 months prior to the start of therapy). All registered platelet count measurements from 24-week following cessation of antiviral therapy were included in repeated measurement analyses. RESULTS: This study included 464 patients; 353 (76%) had cirrhosis and 187 (40%) attained sustained virological response (SVR). Among patients with SVR, median platelet count, increased by 35 × 10(9) /L (IQR 7-62, P < 0.001). In comparison, patients without SVR showed a median decline of 17 × 10(9) /L (IQR -5-47, P < 0.001). In a subgroup of 209 patients, median decrease in spleen size was 1.0 cm (IQR 0.3-2.0) for patients with SVR, while median spleen size increased with 0.6 cm (IQR -0.1-2.0, P < 0.001) among those without SVR. The changes in spleen size and platelet count were significantly correlated (R = -0.41, P < 0.001). CONCLUSIONS: Among chronic HCV-infectedpatients with advanced hepatic fibrosis, the platelet counts improved following SVR and the change in platelets correlated with the change in spleen size following antiviral therapy. These results suggest that HCV eradication leads to reduced portal pressure.
Authors: Suresh Gorka; Ghulam M Gulzar; Ghulam N Yattoo; Jaswinder S Sodhi; Gulzar A Dar; Mushtaq A Laway; Saurabh Kaushik; Neeraj Dhar; Syed Mushfiq; Riffat A Aziz Journal: J Clin Exp Hepatol Date: 2019-07-19
Authors: Veronika Pietsch; Katja Deterding; Dina Attia; Kristina Imeen Ringe; Benjamin Heidrich; Markus Cornberg; Michael Gebel; Michael Peter Manns; Heiner Wedemeyer; Andrej Potthoff Journal: United European Gastroenterol J Date: 2018-06-27 Impact factor: 4.623