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Partial splenic embolization for thrombocytopenia in liver cirrhosis: predictive factors for platelet increment and risk factors for major complications

  • Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To investigate the predictors of platelet increment and risk factors for major complications after partial splenic embolization (PSE) in cirrhosis.

Methods

Between March 2010 and June 2012, 52 cirrhotic patients with severe thrombocytopenia underwent PSE. Multiple variables were analyzed to identify the correlated factors affecting platelet increment and major complications after PSE.

Results

Linear mixed model analysis indicated the splenic infarction ratio (P < 0.001), non-infarcted splenic volume (P = 0.012), and cholinesterase level (P < 0.001) were significantly associated with the platelet increment after PSE. In receiver operating characteristic (ROC) analysis, the cut-off values of the splenic infarction ratio, and non-infarcted splenic volume for achieving an increment of ≥60.0 × 109/L in platelet counts at 1 year after PSE were 64.3 % and 245.8 mL, respectively. After PSE, eight patients developed major complications. Multivariate logistic regression analysis indicated major complications were significantly associated with the infarcted splenic volume (P = 0.024) and Child-Pugh score (P = 0.018). In ROC analysis, the cut-off values of these two factors for discriminating the uncomplicated and complicated were 513.1 mL and 9.5, respectively.

Conclusions

The platelet increment after PSE depends on the splenic infarction ratio, non-infarcted splenic volume and cholinesterase level. But a large infarcted splenic volume and a high Child-Pugh score may cause complications.

Key Points

• The platelet increment after PSE greatly depends on the splenic infarction ratio.

• The non-infarcted splenic volume significantly affects the efficacy of PSE.

• A high cholinesterase level contributes to the improvement of thrombocytopenia after PSE.

• The non-infarcted splenic volume significantly affects the relapse of hypersplenism.

• Complications are significantly associated with the infarcted splenic volume and Child-Pugh score.

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Abbreviations

PSE:

Partial splenic embolization

TPO:

Thrombopoietin

CT:

Computed tomography

ROC:

Receiver operating characteristic

AST:

Aspartate aminotransferase

ALT:

Alanine aminotransferase

CI:

Confidence interval

OR:

Odds ratio

β :

Standardized regression coefficient

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Acknowledgments

The scientific guarantor of this publication is Kangshun Zhu (Deputy director of Radiology Department, the Third Affiliated Hospital, and Interventional Radiology Institute, Sun Yat-sen University). The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. This study has received funding by the National Natural Science Foundation of China (Grant No. 81371655), Science and Technology Planning Project of Guangdong Province, China (Grant No. 2010B031600211), and Science and Technology Planning Project of Guangzhou, Guangdong Province, China (Grant No. 2013 J4100118). Xingxuan Wen (Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-Sen University) kindly provided statistical advice for this manuscript. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, diagnostic or prognostic study / observational, performed at one institution.

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    Authors and Affiliations

    1. Department of Radiology, the Third Affiliated Hospital, and Interventional Radiology Institute, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, Guangdong, 510630, China

      Mingyue Cai, Wensou Huang, Zhengran Li, Jiesheng Qian, Mingsheng Huang, Zhaolin Zeng, Jingjun Huang, Hong Shan & Kangshun Zhu

    2. Department of Infectious Diseases, the Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, Guangdong, 510630, China

      Chaoshuang Lin

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    1. Mingyue Cai
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    Correspondence to Kangshun Zhu.

    Additional information

    Mingyue Cai, Wensou Huang and Chaoshuang Lin contributed equally to this work.

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    Cai, M., Huang, W., Lin, C. et al. Partial splenic embolization for thrombocytopenia in liver cirrhosis: predictive factors for platelet increment and risk factors for major complications. Eur Radiol 26, 370–380 (2016). https://doi.org/10.1007/s00330-015-3839-4

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    • DOI: https://doi.org/10.1007/s00330-015-3839-4

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