Decreased platelet activation predicts hepatic decompensation and mortality in patients with cirrhosis

Benedikt S Hofer; Ksenia Brusilovskaya; Benedikt Simbrunner; Lorenz Balcar; Beate Eichelberger; Silvia Lee; Lukas Hartl; Philipp Schwabl; Mattias Mandorfer; Simon Panzer; Thomas Reiberger; Thomas Gremmel

doi:10.1097/HEP.0000000000000740

Decreased platelet activation predicts hepatic decompensation and mortality in patients with cirrhosis

Hepatology. 2023 Dec 27. doi: 10.1097/HEP.0000000000000740. Online ahead of print.

Authors

Benedikt S Hofer^{1

2

3

4}, Ksenia Brusilovskaya^{1

3

4}, Benedikt Simbrunner^{1

2

3

4}, Lorenz Balcar^{1

2}, Beate Eichelberger⁵, Silvia Lee⁶, Lukas Hartl^{1

2}, Philipp Schwabl^{1

2

3

4}, Mattias Mandorfer^{1

2}, Simon Panzer⁵, Thomas Reiberger^{1

2

3

4}, Thomas Gremmel^{7

8

9}

Affiliations

¹ Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.
² Vienna Hepatic Hemodynamic Laboratory, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.
³ Christian Doppler Lab for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria.
⁴ Center for Molecular Medicine (CeMM) of the Austrian Academy of Sciences, Vienna, Austria.
⁵ Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria.
⁶ Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
⁷ Institute of Cardiovascular Pharmacotherapy and Interventional Cardiology, Karl Landsteiner Society, St. Pölten, Austria.
⁸ Department of Internal Medicine I, Cardiology and Intensive Care Medicine, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria.
⁹ Karl Landsteiner University of Health Sciences, Krems, Austria.

PMID: 38150294
DOI: 10.1097/HEP.0000000000000740

Abstract

Background and aims: Patients with cirrhosis show alterations in primary hemostasis, yet prognostic implications of changes in platelet activation remain controversial, and assay validity is often limited by thrombocytopenia. We aimed to study the prognostic role of platelet activation in cirrhosis, focusing on bleeding/thromboembolic events, decompensation, and mortality.

Approach and results: We prospectively included 107 patients with cirrhosis undergoing a same-day hepatic venous pressure gradient (HVPG) and platelet activation measurement. Platelet activation was assessed using flow cytometry after protease-activated receptor (PAR)-1, PAR-4, or epinephrine stimulation. Over a follow-up of 25.3 (IQR: 15.7-31.2) months, first/further decompensation occurred in 29 patients and 17 died. More pronounced platelet activation was associated with an improved prognosis, even after adjusting for systemic inflammation, HVPG, and disease severity. Specifically, higher PAR-4-inducible platelet activation was independently linked to a lower decompensation risk [adjusted HR per 100 MFI (median fluorescence intensity): 0.95 (95% CI: 0.90-0.99); p =0.036] and higher PAR-1-inducible platelet activation was independently linked to longer survival [adjusted HR per 100 MFI: 0.93 (95% CI: 0.87-0.99); p =0.040]. Thromboembolic events occurred in eight patients (75% nontumoral portal vein thrombosis [PVT]). Higher epinephrine-inducible platelet activation was associated with an increased risk of thrombosis [HR per 10 MFI: 1.07 (95% CI: 1.02-1.12); p =0.007] and PVT [HR per 10 MFI: 1.08 (95% CI: 1.02-1.14); p =0.004]. In contrast, of the 11 major bleedings that occurred, 9 were portal hypertension related, and HVPG thus emerged as the primary risk factor.

Conclusions: Preserved PAR-1- and PAR-4-inducible platelet activation was linked to a lower risk of decompensation and death. In contrast, higher epinephrine-inducible platelet activation was a risk factor for thromboembolism and PVT.