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Scandinaro A, Haider M, Saef J, Farwati M, Allende D, Ghobrial J, Zahka K, O'Shea R, Fares M. Hematologic abnormalities as a marker of cirrhosis after Fontan completion. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
More patients with functioning single ventricle are living into adulthood due to improved survival with the Fontan procedure. Therefore, screening and detection of late-stage complications such as Fontan Associated Liver Disease (FALD) has become increasingly important to improve outcomes. The role of hematologic abnormalities as a marker of cirrhosis in this population is evolving.
Purpose
We aimed to evaluate the value of hematologic parameters in predicting the presence of cirrhosis in the context of FALD.
Methods
This was a retrospective study of patients after Fontan completion who underwent liver biopsy between 2007 and 2019 at our institution. Biopsy slides were evaluated for the presence of cirrhosis by a single pathologist. Laboratory testing was recorded within 12 months of the liver biopsy. Univariable analysis was conducted with an alpha level of 0.05 for hypothesis testing.
Results
A total of 31 Fontan patients with liver biopsies were identified, of whom 7 patients were found to have cirrhosis (Table 1). Compared to patients with no cirrhosis on biopsy, cirrhotic patients tended to have lower hematologic counts including absolute lymphocyte count (0.78 vs 1.02, p=0.019), hemoglobin (12.5 vs 15.1, p=0.018), and platelets (131 vs 194, p=0.025). Notably, the MELD-XI score (Model for End-stage Liver Disease excluding INR) as well as its individual components, creatinine and total bilirubin, were not different between the groups.
Conclusion
Our data suggests that hematologic parameters including absolute lymphocyte count might be of value in predicting cirrhosis on liver biopsy following Fontan completion. Further research to validate these findings in other cohorts is warranted.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Scandinaro
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - M Haider
- Tulane University, New Orleans, United States of America
| | - J Saef
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - M Farwati
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - D Allende
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - J Ghobrial
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - K Zahka
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - R O'Shea
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - M Fares
- Cleveland Clinic Foundation, Cleveland, United States of America
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