Baseline thrombopoietin level is associated with platelet count improvement in thrombocytopenic chronic hepatitis C patients after successful direct-acting antiviral agent therapy

Abstract

Background Thrombocytopenia can rapidly improve in chronic hepatitis C (CHC) patients receiving direct-acting antiviral agents (DAA). The role of baseline (BL) thrombopoietin (TPO) in this phenomenon is unclear. Methods From June 2016 to February 2019, a total of 104 CHC patients receiving DAA, with a sustained virologic response and BL thrombocytopenia, at Dalin Tzu Chi Hospital, were enrolled in this retrospective study. Significant platelet count improvement and platelet count improvement ratio were analyzed for correlation with BL TPO. Results This cohort included 40 men (38.5%). Seventy-two (69.2%) patients had advanced fibrosis. The platelet count [median (range)] increased from 110.5 (32–149) × 103/µL at BL to 116.5 (40–196) and 118.0 (35–275) × 103/µL at end of treatment (EOT) and 12 weeks after EOT (P12), respectively, (EOT vs. BL, P < 0.001; P12 vs. BL, P < 0.001). BL TPO was positively correlated with significant platelet count improvement (P < 0.001), platelet count improvement ratio at EOT (P = 0.004), and P12 (P < 0.001). The area under the receiver operating characteristic curve and optimal cutoffs (pg/ml) were 0.77 (95% confidence interval, 0.67–0.86) and 120, respectively, for significant platelet count improvement prediction. The sensitivity, specificity, and accuracy were 88.6%, 71.7%, and 78.8%, respectively. Conclusions BL TPO level might be a useful marker for predicting significant platelet count improvement in thrombocytopenic patients after successful DAA therapy.

Factors Associated with Significant Platelet Count Improvement in Thrombocytopenic Chronic Hepatitis C Patients Receiving Direct-Acting Antivirals

“…Some of these studies did not investigate the predictive factors of significant platelet count improvement. Besides, our previous studies only showed that the fatty liver, baseline platelet counts, and baseline thrombopoietin level were related to significant platelet count improvement [13,15]. In this larger-scale study, we found that age, baseline platelet counts, baseline total bilirubin levels, and cirrhosis were negatively correlated, but the presence of DM was positively correlated with significant platelet count improvement (Table 2).…”

“…Platelet counts can improve immediately after DAA treatment in CHC patients [11][12][13][14][15]. Some of these studies did not investigate the predictive factors of significant platelet count improvement.…”

“…In thrombocytopenic CHC patients who will have an elective invasive procedure, DAA treatment might be helpful to improve platelet counts in addition to platelet transfusion alone. Our previous study that enrolled CHC patients receiving DAA therapy revealed that patients without significant platelet count improvement would have more advanced hepatic fibrosis and more liver-related complications such as HCC, splenomegaly, and ascites [15]. However, the sample size of that study was relatively small.…”

“…IFN-free direct-acting antivirals (DAAs) have been the standard treatment for CHC [7][8][9][10]. Platelet count improvement has also been reported, and could be observed within a short-term follow-up period [11][12][13][14][15]. Liver fibrosis status is less likely to improve rapidly and significantly immediately after initiation of DAA therapy [16].…”

Impact of direct-acting antiviral regimens on hepatic and extrahepatic manifestations of hepatitis C virus infection

“…Thrombocytopenia is a common complication in chronic HCV infection, causing an increased risk of bleeding[ 94 , 95 ]. The prevalence and severity of thrombocytopenia increase with the progression of liver disease and the development of hepatocellular damage and hepatic fibrosis[ 96 ].…”