Predictors and implications of severe hypersplenism in patients with cirrhosis

Background and Objectives: Hypersplenism is frequently seen in patients with cirrhosis. However, it is unclear why some patients with cirrhosis develop marked hypersplenism and others do not. Additionally, the implications of severe hypersplenism are unknown. Therefore, we conducted a study to evaluate the predictors and implications of severe hypersplenism in patients with cirrhosis. Subjects and Methods: All subjects with cirrhosis who were referred to Indiana University over a 53-month period for liver transplantation were studied. Severe hypersplenism was defined as platelet count < 75,000 per mm(3) and/or white blood cell count < 2,000 per mm(3) in the presence of splenomegaly. The outcomes of interest were development of spontaneous bacterial peritonitis (SBP), variceal bleeding, and death. Patients were observed until death, transplantation, or study closure. Results: The study group comprised 329 subjects with cirrhosis and their median follow-up time was 450 days (0.25 - 42 months). The prevalence of severe hypersplenism was 33%. Decompensated liver disease [odds ratio (OR), 2.0; 95% confidence interval (CI), 1.1 - 3.7] and a history of alcohol consumption (OR 2.3; 95% CI, 1.4 - 3.8) were independent predictors of severe hypersplenism. The presence of severe hypersplenism independently predicted the development of variceal bleeding [hazard ratio (HR) 4.1; 95% CI, 1.7 - 10], SBP (HR 8.0; 95% CI, 3.1 - 20.5), and death (HR 2.0; 95% CI 1.2 - 3.4). Conclusions: This study suggests that severe hypersplenism is an independent risk factor for developing variceal bleeding, SBP, and death in patients with cirrhosis. If these observations are confirmed, severe hypersplenism can be considered as an indication for prophylactic measures against variceal bleeding and SBP.