DAY 1: Thrombocytopenia May Be an Early Predictor for the Onset of Cirrhosis In Metabolic Dysfunction-Associated Steatohepatitis

Declining platelet levels may provide important clues regarding the onset of cirrhosis in people diagnosed with metabolic dysfunction-associated steatohepatitis (MASH), according to findings presented at the 2025 Annual Scientific Meeting of the American College of Gastroenterology in Phoenix, Arizona.

“Early identification of patients at risk for cirrhosis is critical for improving long-term outcomes,” lead author Aditya Avula, DO said during a poster presentation. “While platelet-based scoring systems lack accuracy compared to imaging for diagnosis, they may still serve as early indicators.”

A single platelet count cannot lead to a definitive diagnosis for cirrhosis. Nevertheless, this laboratory value can play a role in noninvasive scoring systems used to assess the degree of liver fibrosis, or may be used in combination with other parameters to track trends over time. Avula and colleagues conducted a retrospective observational cohort analysis using electronic health record data recorded between January 1, 2014 and July 1, 2023 at CHI Health Creighton University Medical Center in Omaha, Nebraska, to examine the timing of thrombocytopenia in relation to the onset of cirrhosis and to assess its potential as a screening tool.

The investigators reviewed all recorded platelet levels obtained from 303 patients who were eventually diagnosed with MASH cirrhosis to identify the time between the first platelet count abnormality (< 150,000/µL) and the onset of cirrhosis. They subsequently used regression models to evaluate trends in platelet counts over time, leading up to the diagnosis. At the time of diagnosis, the participants had a mean MELD-Na score of 24.6, and presented with varying degrees of liver damage: 41 patients were classified as Child-Pugh A, 198 were classified as Child-Pugh B, and 64 were classified as Child-Pugh C.

The participants had an average platelet count of 111,000/uL at diagnosis. The analysis showed that platelet counts began to decrease as early as 10 years before the diagnosis of cirrhosis. From 10 to 5 years before diagnosis, platelet counts decreased by 23 units per month. The decline increased to 91 units per month starting 5 years prior to diagnosis up to the time of diagnosis. The difference in the rates of platelet decrease was not influenced by Child-Pugh score. However, stratification by MELD-Na scores revealed that the rates of platelet decline accelerated in patients with higher MELD-Na scores (30 and 40) in the years leading up to a cirrhosis diagnosis, suggesting a link between the severity of thrombocytopenia and the progression of end-stage liver disease. 

“In our study, thrombocytopenia became statistically significant approximately 9 months before a cirrhosis diagnosis, with a steeper decline observed in patients with higher MELD-Na scores, suggesting more aggressive disease progression,” Avula concluded. “These findings [suggest] that platelet trends, particularly in high-risk groups, may serve as an early indicator of the onset of cirrhosis.”