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. 2020 Jan;40(1):194-204.
doi: 10.1111/liv.14229. Epub 2019 Sep 13.

Prevalence of and risk factors for anaemia in patients with advanced chronic liver disease

Bernhard Scheiner  1   2 , Georg Semmler  1   2 , Florian Maurer  1   2 , Philipp Schwabl  1   2 , Theresa A Bucsics  1   2 , Rafael Paternostro  1   2 , David Bauer  1   2 , Benedikt Simbrunner  1   2 , Michael Trauner  1 , Mattias Mandorfer  1   2 , Thomas Reiberger  1   2
Affiliations

Prevalence of and risk factors for anaemia in patients with advanced chronic liver disease

Bernhard Scheiner et al. Liver Int. 2020 Jan.

Abstract

Background: Anaemia is common in advanced chronic liver disease (ACLD) as a result of various risk factors.

Aims & methods: We evaluated the prevalence and severity of anaemia as well as the impact of anaemia on clinical outcomes in consecutive patients with ACLD and portal hypertension.

Results: Among 494 patients, 324 (66%) patients had anaemia. Anaemic patients showed higher MELD (12 ± 4 vs 9 ± 3; P < .001), lower albumin (34 ± 6 vs 39 ± 5 g/dL; P < .001) and more often Child-Pugh B/C stage (56% vs 17%; P < .001). The prevalence of moderate-severe anaemia (haemoglobin <10 g/dL) increased with the degree of portal hypertension (HVPG: 6-9 mm Hg: 22% vs HVPG: 10-19 mm Hg: 24% vs HVPG ≥ 20 mm Hg: 36%; P = .031). The most common aetiologies of anaemia were gastrointestinal bleeding (25%) and iron deficiency (9%), while reason for anaemia remained unclear in 53% of cases. Male gender (odds ratio [OR]: 1.94 [95% CI: 1.09-3.47]; P = .025), MELD (OR: 1.20 [95% CI: 1.09-1.32]; P < .001), hepatic decompensation (OR: 4.40 [95% CI: 2.48-7.82]; P < .001) and HVPG (OR per mm Hg: 1.07 [95% CI: 1.02-1.13]; P = .004) were independent risk factors for anaemia. Anaemia was associated with hepatic decompensation (1 year: 25.1% vs 8.1%; 5 years: 60.3% vs 32.9%; P < .0001), hospitalization (73% vs 57%; P < .001) and a higher incidence rate of acute-on-chronic liver failure (0.05 [95% CI: 0.04-0.07] vs 0.03 [95% CI: 0.01-0.04]). Anaemic patients had worse overall survival (1 year: 87.1% vs 93.7%, 5 year survival: 50.5% vs 68.6%; P < .0001) and increased liver-related mortality (1 year mortality: 9.7% vs 5.7%, 5 year mortality: 38.0% vs 26.9%; P = .003).

Conclusion: Two-thirds of patients with ACLD suffer from anaemia. The degree of hepatic dysfunction and of portal hypertension correlate with severity of anaemia. Anaemia is associated with decompensation, ACLF and increased mortality in patients with ACLD.

Keywords: advanced chronic liver disease; anaemia; portal hypertension; prevalence; severity.

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Conflict of interest statement

The authors have nothing to disclose regarding the work under consideration for publication. The following authors disclose conflict of interests outside the submitted work: BS received travel support from AbbVie and Gilead. PS received speaker fees from Boehringer Ingelheim and Roche as well as travel support from Boehringer Ingelheim, Gilead and Roche. TB received travel support from Gilead, BMS, Roche, Bayer and AbbVie. MT received grant support from Cymabay, Falk, Gilead, Intercept, MSD and, Takeda, honoraria for consulting from AbbVie, Gilead, Intercept, Janssen, Novartis and Regulus, speaker fees from Boehringer Ingelheim, Falk, Gilead, and MSD as well as travel support from Abbvie, Gilead and Intercept. MM has served as a speaker and consultant for AbbVie, BMS, Gilead, Gore and Janssen. TR received speaker fees from Boehringer Ingelheim, Roche, WL Gore and MSD, grant support from Boehringer Ingelheim, Boston Scientific, Cook Medical, Gilead, Guerbet, Abbvie, Phenex Pharmaceuticals, Philips, WL Gore, and MSD, served as a consultant for Abbvie, Bayer, Boehringer Ingelheim, Gilead, Intercept and MSD and received travel support from Gilead, Roche, MSD and Gore. GS, FM, RP, DB and BSi have nothing to disclose.

Figures

Figure 1
Figure 1
Patient flowchart. HVPG, hepatic venous pressure gradient; TE, transient elastography; Hb haemoglobin
Figure 2
Figure 2
Correlation between degree of anaemia and portal pressure (HVPG). HVPG, hepatic‐venous pressure gradient
Figure 3
Figure 3
Hepatic decompensation during follow‐up in (A) patients with and without anaemia and in (B) groups of patients with different severity of anaemia
Figure 4
Figure 4
Comparison of (A) overall survival and (B) liver‐related mortality between patients with and without anaemia as well as (C) overall survival and (D) liver‐related survival in groups of patients with different severity of anaemia
See this image and copyright information in PMC

References

    1. Guralnik JM, Eisenstaedt RS, Ferrucci L, Klein HG, Woodman RC. Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia. Blood. 2004;104(8):2263‐2268. - PubMed
    1. Denny SD, Kuchibhatla MN, Cohen HJ. Impact of anemia on mortality, cognition, and function in community‐dwelling elderly. Am J Med. 2006;119(4):327‐334. - PubMed
    1. Beghe C, Wilson A, Ershler WB. Prevalence and outcomes of anemia in geriatrics: a systematic review of the literature. Am J Med. 2004;116(Suppl 7A):3s‐10s. - PubMed
    1. Gaskell H, Derry S, Andrew Moore R, McQuay HJ. Prevalence of anaemia in older persons: systematic review. BMC Geriatr. 2008;8:1. - PMC - PubMed
    1. Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med. 2005;352(10):1011‐1023. - PubMed

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