Association of severe thrombocytopenia with prognosis following transjugular intrahepatic portosystemic shunt in cirrhotic patients with portal hypertension

doi:10.4240/wjgs.v18.i7.120610

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Publication Name

World Journal of Gastrointestinal Surgery

ISSN

1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Surg. Jul 27, 2026; 18(7): 120610
Published online Jul 27, 2026. doi: 10.4240/wjgs.v18.i7.120610

Association of severe thrombocytopenia with prognosis following transjugular intrahepatic portosystemic shunt in cirrhotic patients with portal hypertension

Liu Zhang, Shi-Qi Xu, Yi-Jiang Zhu, Li Dong, Liang Yin, Jin-Chang Xiao, De-Lei Cheng, Rui-Feng Wang, Chun-Ze Zhou

Liu Zhang, Shi-Qi Xu, Chun-Ze Zhou, School of Graduate, Bengbu Medical University, Bengbu 233030, Anhui Province, China

Liu Zhang, Shi-Qi Xu, Yi-Jiang Zhu, Li Dong, Liang Yin, De-Lei Cheng, Chun-Ze Zhou, Department of Interventional Radiology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China

Jin-Chang Xiao, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221006, Jiangsu Province, China

Rui-Feng Wang, The Second Affiliated Hospital of Anhui Medical University, Hefei 230001, Anhui Province, China

Co-first authors: Liu Zhang and Shi-Qi Xu.

Co-corresponding authors: Rui-Feng Wang and Chun-Ze Zhou.

Author contributions: Zhou CZ contributed to the study conception and design, Wang RF participated in the data analysis and manuscript revision, and they are co-corresponding authors; Cheng DL provided academic guidance and supervision for this work; Zhang L, Zhu YJ, Yin L, Dong L and Xiao JC contributed to material preparation, data collection and analysis; Zhang L and Xu SQ contributed to the first draft of the manuscript as co-first authors; all authors commented on previous versions of the manuscript, read and approved the final manuscript.

AI contribution statement: Grammarly and DeepL were used for language polishing and Chinese-to-English translation assistance. DeepSeek was used to help refine the phrasing and structure of certain sections, particularly in the introduction and discussion. All AI-generated content was thoroughly reviewed, fact-checked, substantially revised, and rewritten by the authors to ensure scientific accuracy and originality. The study design, inclusion/exclusion criteria, statistical analysis plan, and interpretation of clinical results were performed entirely by the authors. No AI image generation tools were used.

Supported by the National Natural Science Foundation of China, No. 82370748; the Scientific Research Foundation of the Education Department of Anhui Province, No. 2022AH040189; and the Anhui Provincial Health Commission Scientific Research Project, No. AHWJ2024Aa10141.

Institutional review board statement: The study protocol was conducted in accordance with the ethical principles of the Declaration of Helsinki and was approved by the Institutional Ethics Committee of the First Affiliated Hospital of the University of Science and Technology of China (approval No. 2024-RE-404).

Informed consent statement: Given the retrospective and fully anonymized nature of this study, the requirement for informed consent was waived by the Institutional Ethics Committee.

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.

Data sharing statement: The datasets generated and analyzed during this study are available from the corresponding author upon reasonable request.

Corresponding author: Chun-Ze Zhou, MD, Assistant Professor, School of Graduate, Bengbu Medical University, No. 2600 Donghai Avenue, Bengbu 233030, Anhui Province, China. zhouchunze@ustc.edu.cn

Received: March 4, 2026
Revised: March 20, 2026
Accepted: April 10, 2026
Published online: July 27, 2026
Processing time: 145 Days and 18.5 Hours

Abstract

BACKGROUND

Cirrhotic portal hypertension (CPH) is frequently complicated by variceal bleeding and ascites, for which transjugular intrahepatic portosystemic shunt (TIPS) represents a key therapeutic intervention. Thrombocytopenia (TCP) is prevalent in these patients; however, the prognostic significance of severe TCP, defined as a platelet count < 50 × 10⁹/L, on TIPS outcomes remains unclear.

AIM

To evaluate the impact of severe TCP (platelet count < 50 × 10⁹/L) on mortality and bleeding risk following TIPS.

METHODS

This multicenter, retrospective cohort study included CPH patients who underwent TIPS between 2014 and 2023 and were stratified into non-severe and severe TCP groups. Overall survival (OS) served as the primary outcome. To reduce potential confounding, we conducted 1:1 propensity score matching (PSM).

RESULTS

A total of 434 patients were analyzed (131 with severe TCP and 303 with non-severe TCP). Prior to PSM, the severe TCP group had significantly worse 90-day [hazard ratio (HR) = 2.65] and 1-year (HR = 2.18) survival. After PSM (n = 90 per group), however, no significant difference in survival was observed at any time point. Multivariate analysis further confirmed that severe TCP was not independently associated with OS after adjustment via PSM. Severe TCP was linked to a higher incidence of minor bleeding (47.1% vs 33.5%, P = 0.026) but showed no association with moderate-to-severe or procedural bleeding.

CONCLUSION

Severe TCP is not an independent predictor of mortality after TIPS once liver disease severity is accounted for. Baseline liver dysfunction, not platelet count, is the principal determinant of post-TIPS survival. Clinicians should prioritize comprehensive assessment of liver function over platelet levels when evaluating prognosis in TIPS candidates.

Keywords: Thrombocytopenia; Transjugular intrahepatic portosystemic shunt; Portal hypertension; Liver cirrhosis; Prognosis

Core Tip: In this multicenter study of 434 cirrhotic patients, severe thrombocytopenia (< 50 × 10⁹/L) was initially associated with poorer survival after transjugular intrahepatic portosystemic shunt (TIPS), but this association vanished after adjusting for liver disease severity using propensity score matching. Although severe thrombocytopenia correlated with an increased risk of minor bleeding, it was not linked to moderate-to-severe or procedural hemorrhage. These findings challenge conventional assumptions by demonstrating that baseline liver dysfunction, not platelet count, is the key driver of post-TIPS prognosis. Clinicians should therefore focus on comprehensive liver function evaluation rather than platelet thresholds when assessing TIPS candidates.