Thrombocytopenia is frequent finding in cirrhotic patients treated with piperacillin-tazobactan and is associated with increased morbidity and mortality
AASLD LiverLearning®. Pereira G. Nov 14, 2016; 144944
Topic: Portal Hypertension and Other Complications of Cirrhosis
Label: Infections and Acute on Chronic Liver Failure
Prof. Dr. Gustavo Pereira
Prof. Dr. Gustavo Pereira

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TITLE: Thrombocytopenia is frequent finding in cirrhotic patients treated with piperacillin-tazobactan and is associated with increased morbidity and mortality

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Introduction: Thrombocytopenia is a common feature of cirrhosis. Bacterial infections are frequent in this population and antibiotics are among the most common drugs associated with thrombocytopenia. The coexistence of these factors may render this population susceptible to more frequent and severe forms of thrombocytopenia Piperacillin/Tazobactam(Pip/Tazo), a regimen increasingly used in cirrhosis, has been associated with drug-induced thrombocytopenia in general populations. There is scarce data respect the epidemiology and clinical characteristics of thrombocytopenia in cirrhotic patients treated with Pip/Tazo. Objective: describe the frequency and clinical characteristics of thrombocytopenia as well as their predictive factors and correlation with prognosis in a cohort of cirrhotic patients treated with Pip/Tazo. Methods: consecutive patients hospitalized between October/2011-December/2015 taking Pip/Tazo for at least 5 days were evaluated. Thrombocytopenia was defined by a drop ≥50% from beginning of treatment (baseline) with a final value <75x109/L. Thrombocytopenia was classified as severe if platelet count was < 50x x109/L and as persistent if values at the end of treatment were <75% of baseline. Results: 84 patients (58% male, 60±10 years, HCV±alcohol in 74%, platelet count 117 (76-179)) were included. Child-Pugh and MELD score were 10±1 and 18±8 respectively. SIRS and ACLF were observed in 28% and 24%. Most common type of infections was SBP (25 patients), and the majority of infections were nosocomial (55%). Thrombocytopenia developed in 12 patients (platelet count 39 (25-65)) after 6 (3-12) days. Severe and persistent thrombocytopenia were the most common forms of presentation, observed in 8 and 10 patients respectively. A higher Child-Pugh score and presence of SIRS at diagnosis, as well as a drop in platelet count at day 3, were predictive of thrombocytopenia. Development of thrombocytopenia was associated with a higher frequency of bleeding from central line puncture site (33vs4%,p=0.003), urinary, respiratory (17vs0% for both,p=0.002) and lower GI tract (17vs3%,p=0.04) and of platelet transfusion (17vs1%,p=0.009). Development of severe or persistent thrombocytopenia was correlated with in-hospital mortality (86vs44%,p=0.04). Conclusions: development of thrombocytopenia is frequent in cirrhotic patients treated with Pip/Tazo, especially in those with worst liver function and more severe infection. Even though it occurs relatively late during treatment, an early fall in platelet count may predict it occurrence. Development of this complication, especially in most severe forms, is associated with high morbidity and mortality.
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