Z Gastroenterol 2019; 57(05): e155
DOI: 10.1055/s-0039-1691915
POSTER
Hepatologie
Georg Thieme Verlag KG Stuttgart · New York

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

G Semmler
1   Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna, Austria
2   Medical University of Vienna, Hepatic Hemodynamic Laboratory, Vienna, Austria
,
B Scheiner
1   Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna, Austria
2   Medical University of Vienna, Hepatic Hemodynamic Laboratory, Vienna, Austria
,
F Maurer
1   Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna, Austria
2   Medical University of Vienna, Hepatic Hemodynamic Laboratory, Vienna, Austria
,
M Trauner
1   Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna, Austria
,
M Mandorfer
1   Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna, Austria
2   Medical University of Vienna, Hepatic Hemodynamic Laboratory, Vienna, Austria
,
T Reiberger
1   Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna, Austria
2   Medical University of Vienna, Hepatic Hemodynamic Laboratory, Vienna, Austria
› Author Affiliations
Further Information

Publication History

Publication Date:
16 May 2019 (online)

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Background:

Anemia is common in patients with advanced chronic liver disease (ACLD).

Methods:

We evaluated prevalence, types and severity of anemia in ACLD as well as the relative impact of liver dysfunction and portal pressure. Patients who underwent hepatic venous pressure gradient (HVPG) measurement between 08/2007 and 12/2015 were included in this retrospective study.

Results:

Among 574 patients, 364 (63.4%) presented with anemia including 27 (7.4%) with severe anemia (hemoglobin < 8 g/dL). Male gender (76.4% vs. 66.2%, p = 0.008) and alcoholic etiology (37.1% vs. 17.1%, p < 0.001) were overrepresented in patients with anemia. Furthermore, these patients had lower albumin levels (34.5 ± 5.9 vs. 39.6 ± 4.7, p < 0.001) and higher prevalence of previous hepatic decompensation (65.9% vs. 32.4%, p < 0.001). Importantly, patients with anemia had higher Child-Pugh (45.0% vs. 12.0% Child B/C, p < 0.001) and MELD-scores (11.8 ± 4.3 vs. 9.1 ± 2.6, p < 0.001) and a higher number of patients showed clinically significant portal hypertension (CSPH, HVPG≥10 mmHg, 75.3% vs. 52.8%, p < 0.001).

Severity of anemia increased with degree of PH: moderate-severe anemia (hemoglobin< 10 g/dL) was present in 17.8% of patients with HVPG< 10 mmHg, 23.6% with HVPG 10 – 19 mmHg, and 36.2% with HVPG≥20 mmHg, respectively (p = 0.014). The most common etiologies of anemia were chronic GI-bleeding (22.5%), iron deficiency (8.5%), vitamin B12/folic acid deficiency (7.4%) and renal anemia (4.7%). However, in 56.0% of cases, reason for anemia was not further investigated, and only 8.2% of patients received specific therapies.

In multivariate analysis, male gender (OR: 1.92 (95%CI: 1.16 – 3.20), p = 0.011), previous hepatic decompensation (OR: 3.48 (95%CI: 1.93 – 6.28), p < 0.001), HVPG≥20 mmHg (OR: 3.05 (95%CI: 1.28 – 7.24), p = 0.011) and serum albumin levels below the lower limit of normal (OR: 2.80 (95%CI: 1.52 – 5.14), p = 0.001) were independent risk factors for anemia.

Conclusion:

Anemia is common in patients with ACLD and is associated with the degree of liver dysfunction and portal hypertension. However, diagnostic work-up of anemia in ACLD needs attention and optimal treatment strategies remain to be assessed.