Reticulated platelets are increased and hyper-activated in patients with cirrhosis, especially those with poor outcome

Alberto Zanetto; Serena Toffanin; Elena Campello; Claudia Maria Radu; Sabrina Gavasso; Patrizia Burra; Francesco Paolo Russo; Marco Senzolo; Paolo Simioni

doi:10.1016/j.dld.2024.03.007

Reticulated platelets are increased and hyper-activated in patients with cirrhosis, especially those with poor outcome

Dig Liver Dis. 2024 Mar 28:S1590-8658(24)00308-6. doi: 10.1016/j.dld.2024.03.007. Online ahead of print.

Authors

Alberto Zanetto¹, Serena Toffanin², Elena Campello³, Claudia Maria Radu², Sabrina Gavasso², Patrizia Burra¹, Francesco Paolo Russo¹, Marco Senzolo¹, Paolo Simioni⁴

Affiliations

¹ Gastroenterology and Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padova University Hospital, Padova, Italy.
² Thrombotic and Haemorrhagic Disease Unit and Haemophilia Center, Department of Medicine (DIMED), University of Padova, Italy.
³ Thrombotic and Haemorrhagic Disease Unit and Haemophilia Center, Department of Medicine (DIMED), University of Padova, Italy; General Internal Medicine Unit, Azienda Ospedale - Università Padova, Padova, Italy.
⁴ Thrombotic and Haemorrhagic Disease Unit and Haemophilia Center, Department of Medicine (DIMED), University of Padova, Italy; General Internal Medicine Unit, Azienda Ospedale - Università Padova, Padova, Italy. Electronic address: paolo.simioni@unipd.it.

PMID: 38553338
DOI: 10.1016/j.dld.2024.03.007

Abstract

Background: Reticulated platelets (RePLT) are emergency circulating platelets released to contrast peripheral platelet destruction.

Aim: We conducted a prospective study to [a] characterize RePLT in cirrhosis; [b] evaluate the association between RePLT and hepatic decompensation/death.

Methods: Cirrhosis patients without hepatocellular carcinoma were prospectively recruited and underwent assessment of RePLT and thrombopoietin (TPO). RePLT were evaluated by cytofluorimetry and immuno-fluorescence microscopy. Twenty healthy subjects were included as controls. Patients were followed for 6 months for hepatic decompensation and further decompensation/ACLF.

Results: Forty-five patients were included (Child-Pugh [CP] A/B/C 18/11/16). Compared to controls, RePLT in cirrhosis were significantly increased (0.82% vs. 0.05%; p < 0.001) and hyperactivated (4.35% vs. 0.17%; p = 0.004). No correlation was observed between RePLT and CP, platelet count, TPO, MELD score, and C-reactive protein. TPO was lower in cirrhosis than controls (28 pg/mL vs. 52 pg/mL; p = 0.005), decreasing significantly with CP stage. In CP B/C patients (n = 27), RePLT were significantly higher in those who progressed towards further decompensation/ACLF (2.11 [0.56-2.95] vs. 0.69 [0.02-1.22]; p < 0.01). A proportion of RePLT >2% accurately identified high-risk patients (AUROC 0.818; 95%CI: 0.639-0.997; sensitivity 94%, specificity 73%).

Conclusion: RePLT in cirrhosis are increased and hyper-activated. In decompensated patients, higher RePLT appear to be associated with worse outcomes.

Keywords: Coagulation; Hemostasis; Liver failure; Portal hypertension.