Severe Hepatic Steatosis and Thrombocytopenia Increase Risk of All-Cause, Cardiovascular-Related Mortality

The presence of thrombocytopenia is associated with an increased risk of all-cause mortality and cardiovascular-related mortalities in patients with severe hepatic steatosis, according to the results of a new study.

Previous studies have shown that the presence of thrombocytopenia leads to an increased risk of mortality; however, no studies, to date, have looked at the combined risk of mortality for patients with thrombocytopenia and severe hepatic steatosis. As such, a team of investigators led by Mohamed Elsaid, MPH, Rutgers, the State University of New Jersey, and Robert Wood Johnson Medical School, in New Brunswick, New Jersey, looked at thrombocytopenia as a risk modifier of the link between severe hepatic steatosis and “mortality related to all-cause and cardiovascular disease,” wrote the study authors.

The team of investigators linked national mortality records with data pulled from the Third National Health and Nutrition Examination Survey (NHANES III), on 12,798 adults between the ages of 20 and 74 years. More than 3000 of the study participants (3227) died during the follow-up period (up to 23 years after recruitment); 911 of these deaths were linked with cardiovascular disease.

Prevalence of severe hepatic steatosis (identified and classified via ultrasound) was found to be 6.56% (95% CI; 5.24, 7.67), and the prevalence of thrombocytopenia (platelet count of <150,000 platelets / μl) was found to be significantly higher in those patients (4.56%), versus patients without severe hepatic steatosis (1.43%; P = .0002).

According to the study authors, “severe hepatic steatosis alone was not a significant predictor of mortality,” with the results indicating an adjusted hazard ratio (aHR) of 1.16 (95% CI; 0.99, 1.36) for all-cause mortality and 0.97 (95% CI; 0.65, 1.43) for cardiovascular-related mortality.

In those patients in the study who had thrombocytopenia and severe hepatic steatosis, the risk of all-cause and cardiovascular-related mortalities was aHR 3.14 (95% CI; 1.19, 8.27) versus 4.55 (95% CI; 1.02, 20.30) for those without severe hepatic steatosis.

As a result of the significant interactions between severe hepatic steatosis and thrombocytopenia observed in the adjusted models, the team concluded that the presence of thrombocytopenia was “associated with increased risks of all-cause and cardiovascular-related mortalities due to severe hepatic steatosis.”

The abstract, “The Impact of Thrombocytopenia on the Risk of Mortality Amongst Adult Patients with Severe Hepatic Steatosis: A Population Based Study United States Adults,” was presented at the 2018 American Association for the Study of Liver Diseases (AASLD) Liver Meeting, November 9-13, 2018, in San Francisco, California.