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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World Journal of Gastrointestinal Surgery

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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

Table 1 The baseline characteristics, mean ± SD/n (%)/median (interquartile range)

Characteristics	Pre-match			Post-match
Characteristics	Severe TCP (n = 131)	Non-severe TCP (n = 303)	P value	Severe TCP (n = 90)	Non-severe TCP (n = 90)	P value
Age	53.1 ± 10.4	55.3 ± 12.0	0.069	53.8 ± 10.9	54.1 ± 11.4	0.852
Gender			0.111			0.506
Male	95 (72.5)	196 (64.7)		67 (74.4)	63 (70.0)
Female	36 (27.5)	107 (35.3)		23 (25.6)	27 (30.0)
Etiology of cirrhosis			0.747			0.812
HBV	91 (69.5)	198 (65.3)		68 (75.6)	69 (76.7)
HCV	16 (12.2)	32 (10.6)		6 (6.7)	4 (4.4)
ALD	6 (4.6)	21 (6.9)		3 (3.3)	5 (5.6)
AIH	4 (3.0)	12 (4.0)		3 (3.3)	3 (3.3)
Others	14 (10.7)	40 (13.2)		10 (11.1)	9 (10.0)
TIPS indications			0.484			0.747
Gastrointestinal bleeding	89 (67.9)	216 (71.3)		61 (67.8)	63 (70.0)
Recurrent/refractory ascites	42 (32.1)	87 (28.7)		29 (32.2)	27 (30.0)
Child-Pugh score	7.0 (7.0, 9.0)	7.0 (6.0, 8.0)	0.008	7.0 (6.8, 8.3)	8.0 (7.0, 8.8)	0.562
MELD score	10.6 ± 4.5	8.5 ± 5.0	< 0.001	10.1 ± 4.2	8.5 ± 4.6	0.016
MELD-Na score	9.9 (7.6, 13.3)	8.3 (5.6, 12.3)	< 0.001	9.8 (7.5, 13.6)	8.8 (5.0, 13.6)	0.067
PALBI	-1.8 ± 0.4	-2.5 ± 0.5	< 0.001	-1.9 ± 0.5	-2.4 ± 0.5	< 0.001
ALBI	-1.8 (-2.1, -1.5)	-2.0 (-2.3, -1.6)	0.009	-1.8 (-2.1, -1.5)	-1.9 (-2.2, -1.6)	0.970
Ammonia (μmol/L)	32.6 (19.1, 45.6)	34.4 (19.8, 67.7)	0.363	33.2 (22.9, 45.2)	42.5 (20.3, 69.7)	0.507
Albumin (g/L)	32.6 ± 5.4	33.6 ± 5.3	0.094	33.5 ± 5.6	32.3 ± 5.2	0.148
Hb (g/L)	72.0 (64.0, 87.0)	84.0 (66.0, 109.8)	< 0.001	76 (68.8, 88.0)	69.5 (60.3, 80.3)	0.408
PT (second)	15.8 (13.8, 17.7)	14.3 (12.7, 15.9)	< 0.001	15.8 (14.4, 17.5)	14.3 (12.9, 16.0)	0.001
APTT (second)	39.5 (31.7, 44.3)	34.0 (28.8, 40.6)	< 0.001	37.2 (31.3, 43.3)	33.4 (28.9, 40.5)	0.026
TT (second)	17.6 ± 2.8	18.11 ± 6.8	0.371	17.3 ± 2.7	18.8 ± 9.6	0.143
INR	1.3 (1.2, 1.5)	1.2 (1.0, 1.4)	< 0.001	1.4 (1.2, 1.5)	1.2 (1.1, 1.3)	< 0.001
ALT (U/L)	24.1 (18.0, 34.0)	21.0 (15.0, 33.0)	0.647	24.6 (19.8, 32.9)	20.0 (15.0, 33.5)	0.027
TBIL (μmol/L)	21.9 (15.0, 27.5)	18.8 (13.7, 33.0)	0.063	21.0 (13.8, 30.4)	15.6 (11.2, 24.2)	0.084
Creatinine	58.0 (49.0, 70.0)	65.5 (55.3, 81.0)	0.333	60.6 (51.0, 81.3)	62.0 (51.8, 75.8)	0.817
PLT (× 10⁹/L)	39.0 (33.0, 44.0)	83.0 (61.3, 119.5)	< 0.001	39.1 (31.8, 44.3)	76.0 (62.0, 101.0)	< 0.001
WBC (× 10⁹/L)	2.6 (2.0, 3.7)	4.0 (2.5, 5.8)	< 0.001	2.8 (2.0, 4.3)	3.5 (2.3, 4.8)	0.249
RBC (× 10⁹/L)	2.6 (2.2, 3.0)	3.1 (2.5, 3.9)	< 0.001	2.7 (2.3, 3.2)	2.8 (2.5, 3.3)	0.062
PPG (mmHg)
Before TIPS	26.9 ± 5.9	26.4 ± 5.1	0.577	26.7 ± 5.7	26.9 ± 5.2	0.799
After TIPS	12.8 ± 3.4	11.9 ± 3.4	0.061	12.2 ± 3.7	13.1 ± 3.0	0.215

TCP: Thrombocytopenia; HBV: Hepatitis B virus; HCV: Hepatitis C virus; ALD: Alcoholic liver disease; AIH: Autoimmune hepatitis; TIPS: Transjugular intrahepatic portosystemic shunt; MELD: Model for end-stage liver disease score; MELD-Na: Model for end-stage liver disease sodium score; PALBI: Platelet-albumin-bilirubin index; ALBI: Albumin-bilirubin index; Hb: Hemoglobin; PT: Prothrombin time; APTT: Activated partial thromboplastin time; TT: Thrombin time; INR: International normalized ratio; ALT: Alanine aminotransferase; TBIL: Total bilirubin; PLT: Platelet count; WBC: White blood cell count; RBC: Red blood cell count; PPG: Portosystemic pressure gradient.

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Table 2 Uni- and multivariable Cox regression analyses of the pre-matched cohort

Characteristics	HR	95%CI		P value
Characteristics	HR	Lower	Upper	P value
Univariable Cox regression
Age	1.038	1.018	1.058	< 0.001
Gender	1.084	0.674	1.742	0.740
Severe TCP	1.695	1.078	2.665	0.022
TIPS indications	0.533	0.341	0.834	0.006
WBC	0.962	0.886	1.044	0.355
RBC	0.664	0.500	0.881	0.005
Hb	0.998	0.991	1.006	0.618
PLT	0.997	0.992	1.001	0.165
ALT	0.999	0.996	1.003	0.764
TBIL	1.010	1.004	1.016	< 0.001
Albumin	0.902	0.860	0.946	< 0.001
PT	1.019	0.986	1.053	0.268
INR	1.839	1.049	3.226	0.033
Creatinine	1.006	1.004	1.008	< 0.001
MELD-Na score	1.006	0.996	1.016	0.233
MELD score	1.078	1.029	1.128	0.001
Child-Pugh score	1.284	1.136	1.451	< 0.001
PALBI	2.511	1.668	3.780	< 0.001
ALBI	3.007	1.875	4.820	< 0.001
Model 1 multivariable cox regression
Age	1.046	1.025	1.068	< 0.001
Severe TCP	1.974	1.224	3.184	0.005
Creatinine	1.006	1.004	1.009	< 0.001
Child-Pugh score	1.268	1.109	1.451	< 0.001
Model 2 multivariable cox regression
Age	1.047	1.025	1.068	< 0.001
Severe TCP	1.687	1.054	2.701	0.029
MELD score	1.077	1.025	1.131	0.003
Model 3 multivariable cox regression
Age	1.040	1.020	1.061	< 0.001
Creatinine	1.007	1.004	1.009	< 0.001
PALBI score	2.414	1.566	3.723	< 0.001
Model 4 multivariable cox regression
Age	1.039	1.018	1.060	< 0.001
Severe TCP	2.066	1.298	3.287	0.002
Creatinine	1.007	1.004	1.009	< 0.001
ALBI	2.783	1.689	4.584	< 0.001

HR: Hazard ratio; CI: Confidence interval; TCP: Thrombocytopenia; TIPS: Transjugular intrahepatic portosystemic shunt; WBC: White blood cell count; RBC: Red blood cell count; Hb: Hemoglobin; PLT: Platelet count; ALT: Alanine aminotransferase; TBIL: Total bilirubin; PT: Prothrombin time; INR: International normalized ratio; MELD: Model for end-stage liver disease score; MELD-Na: Model for end-stage liver disease sodium score; PALBI: Platelet-albumin-bilirubin index; ALBI: Albumin-bilirubin index.

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Table 3 Uni- and multivariable Cox regression analyses of the post-matched cohort

Characteristics	HR	95%CI		P value
Characteristics	HR	Lower	Upper	P value
Univariable Cox regression
Age	1.048	1.020	1.076	< 0.001
Gender	1.262	0.658	2.422	0.483
Severe TCP	1.210	0.686	2.133	0.510
TIPS indications	1.182	0.626	2.230	0.607
WBC	1.047	0.953	1.150	0.340
RBC	0.713	0.447	1.137	0.155
Hb	1.004	0.992	1.016	0.550
PLT	1.002	0.996	1.008	0.505
ALT	1.004	1.0003	1.007	0.031
TBIL	1.016	1.009	1.022	< 0.001
Albumin	0.907	0.854	0.964	0.002
PT	1.036	0.983	1.093	0.189
INR	3.036	1.040	8.859	0.042
Creatinine	1.009	1.002	1.017	0.012
MELD-Na score	1.009	0.971	1.048	0.649
MELD score	1.096	1.019	1.180	0.014
Child-Pugh score	1.356	1.149	1.601	< 0.001
PALBI	2.348	1.336	4.124	0.003
ALBI	3.956	2.029	7.713	< 0.001
Model 1 multivariable cox regression
Age	1.041	1.014	1.068	0.003
Creatinine	1.011	1.004	1.018	0.002
Child-Pugh score	1.287	1.076	1.538	0.006
Model 2 multivariable cox regression
Age	1.043	1.016	1.070	0.002
MELD score	1.113	1.034	1.199	0.004
Model 3 multivariable cox regression
Age	1.041	1.013	1.069	0.003
Creatinine	1.012	1.005	1.018	0.001
PALBI	2.164	1.169	4.008	0.014
Model 4 multivariable cox regression
Age	1.039	1.012	1.066	0.004
Creatinine	1.012	1.005	1.018	< 0.001
ALBI	3.886	1.903	7.936	< 0.001

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Table 4 Incidence of postoperative transjugular intrahepatic portosystemic shunt-related bleeding events

	Severe TCP (n = 87)	Non-severe TCP (n = 224)	χ² value	P value
All-cause bleeding events	47	98	2.657	0.103
Minor bleeding events	41	75	4.988	0.026
Moderate to severe bleeding events	13	27	0.467	0.495

TCP: Thrombocytopenia.

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Citation: Zhang L, Xu SQ, Zhu YJ, Dong L, Yin L, Xiao JC, Cheng DL, Wang RF, Zhou CZ. Association of severe thrombocytopenia with prognosis following transjugular intrahepatic portosystemic shunt in cirrhotic patients with portal hypertension. World J Gastrointest Surg 2026; 18(7): 120610
URL: https://www.wjgnet.com/1948-9366/full/v18/i7/120610.htm
DOI: https://dx.doi.org/10.4240/wjgs.v18.i7.120610

Zhang L, Xu SQ, Zhu YJ, Dong L, Yin L, Xiao JC, Cheng DL, Wang RF, Zhou CZ. Association of severe thrombocytopenia with prognosis following transjugular intrahepatic portosystemic shunt in cirrhotic patients with portal hypertension. World J Gastrointest Surg 2026; 18(7): 120610 [DOI: 10.4240/wjgs.v18.i7.120610]

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