{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T18:37:21Z","timestamp":1769711841870,"version":"3.49.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T00:00:00Z","timestamp":1769644800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"1.3.5 Project for Disciplines of Excellence, West China Hospital, Sichuan University","award":["ZYGD23030"],"award-info":[{"award-number":["ZYGD23030"]}]},{"name":"Prevention and Control of Emerging and Major Infectious Diseases-National Science and Technology Major Project","award":["2025ZD01906500"],"award-info":[{"award-number":["2025ZD01906500"]}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"\n Background<\/jats:title>\n Platelet reduction is associated with an increased risk of bleeding in patients with chronic liver disease. However, the association between platelet levels and bleeding events in patients with liver failure treated with an artificial liver support system (ALSS) remains unclear.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This retrospective study included patients with acute-on-chronic liver failure (ACLF) who received ALSS treatment. Logistic and linear regression analyses were employed to assess the association between platelet levels and bleeding events during hospitalization and the relationship between sessions of ALSS treatment and platelet reduction rates.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n We included 262 patients, of whom 56 (21.4%) experienced bleeding events during hospitalization. Baseline platelet levels in patients with bleeding events were significantly lower than those in patients without bleeding events (59.0 (39.0\u202f~\u202f89.3)\u202f\u00d7\u202f10\n 9<\/jats:sup>\n \/L vs. 88.5 (57.0\u202f~\u202f121.0)\u202f\u00d7\u202f10\n 9<\/jats:sup>\n \/L;\n p<\/jats:italic>\n \u202f&lt;\u202f0.001). Baseline platelet levels were negatively associated with bleeding events (adjusted OR, 0.986; 95% CI, 0.976\u20130.996;\n p<\/jats:italic>\n \u202f=\u202f0.006), whereas platelet reduction rates and final platelet levels were not significantly associated with bleeding events (all\n p<\/jats:italic>\n \u202f&gt;\u202f0.05). Compared to patients with baseline platelet grade 0, the risk of bleeding was significantly higher compared to those with baseline platelet grade 1 (adjusted OR: 3.21, 95% CI: 1.20\u202f~\u202f8.59,\n p<\/jats:italic>\n \u202f=\u202f0.002) and grade 2 (adjusted OR: 7.20, 95% CI: 2.28\u202f~\u202f21.43,\n p<\/jats:italic>\n \u202f=\u202f0.001), as well as in the combined group of grades 2 and 3 (adjusted OR: 8.43, 95% CI: 2.96\u202f~\u202f23.99,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001). The number of ALSS treatment sessions was not significantly associated with platelet reduction rates (\n p<\/jats:italic>\n \u202f&gt;\u202f0.05).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Patients with ACLF who underwent ALSS treatment with lower baseline platelet levels were at an increased risk of bleeding during hospitalization, whereas the platelet reduction rate was not independently associated with bleeding risk. These findings underscore the importance of baseline platelet count rather than platelet reduction for early risk stratification in patients with ACLF.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fmed.2026.1718780","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T06:40:13Z","timestamp":1769668813000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between platelet levels and bleeding events in patients with acute-on-chronic liver failure treated with an artificial liver support system"],"prefix":"10.3389","volume":"13","author":[{"given":"Li","family":"Yang","sequence":"first","affiliation":[{"name":"Center of Infectious Diseases, West China Hospital of Sichuan University","place":["Chengdu, China"]},{"name":"Department of Infectious Diseases, People's Hospital of Jianyang City","place":["Jianyang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fang","family":"Chen","sequence":"additional","affiliation":[{"name":"Center of Infectious Diseases, West China Hospital of Sichuan University","place":["Chengdu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lingyao","family":"Du","sequence":"additional","affiliation":[{"name":"Center of Infectious Diseases, West China Hospital of Sichuan University","place":["Chengdu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuanji","family":"Ma","sequence":"additional","affiliation":[{"name":"Center of Infectious Diseases, West China Hospital of Sichuan University","place":["Chengdu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lang","family":"Bai","sequence":"additional","affiliation":[{"name":"Center of Infectious Diseases, West China Hospital of Sichuan University","place":["Chengdu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hong","family":"Tang","sequence":"additional","affiliation":[{"name":"Center of Infectious Diseases, West China Hospital of Sichuan University","place":["Chengdu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,29]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"S27","DOI":"10.1016\/j.jhep.2020.11.047","article-title":"Acute-on-chronic liver failure: a distinct clinical syndrome","volume":"75","author":"Moreau","year":"2021","journal-title":"J Hepatol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1336","DOI":"10.1016\/j.jhep.2012.06.026","article-title":"Acute-on chronic liver failure","volume":"57","author":"Jalan","year":"2012","journal-title":"J Hepatol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1136\/gutjnl-2020-322161","article-title":"Global burden of disease: acute-on-chronic liver failure, a systematic review and meta-analysis","volume":"71","author":"Mezzano","year":"2022","journal-title":"Gut"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"4359","DOI":"10.1016\/j.transproceed.2005.11.044","article-title":"Effects of artificial liver support system on patients with acute or chronic liver failure","volume":"37","author":"Du","year":"2005","journal-title":"Transplant Proc"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1016\/j.jhep.2015.03.018","article-title":"Efficacy of coupled low-volume plasma exchange with plasma filtration adsorption in treating pigs with acute liver failure: a randomised study","volume":"63","author":"Zhou","year":"2015","journal-title":"J Hepatol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"677","DOI":"10.1097\/SLA.0000000000002361","article-title":"Molecular adsorbent recirculating system effectively replaces hepatic function in severe acute liver failure","volume":"266","author":"Hanish","year":"2017","journal-title":"Ann Surg"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1616","DOI":"10.1097\/ccm.0000000000002562","article-title":"Molecular adsorbent recirculating system can reduce short-term mortality among patients with acute-on-chronic liver failure-a retrospective analysis","volume":"45","author":"Gerth","year":"2017","journal-title":"Crit Care Med"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1111\/aas.13268","article-title":"Bleeding and thrombosis in intensive care patients with thrombocytopenia-protocol for a topical systematic review","volume":"63","author":"Jonsson","year":"2019","journal-title":"Acta Anaesthesiol Scand"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"689","DOI":"10.1016\/j.cgh.2009.02.021","article-title":"Incidence, prevalence, and clinical significance of abnormal hematologic indices in compensated cirrhosis","volume":"7","author":"Qamar","year":"2009","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"2210","DOI":"10.1111\/liv.13873","article-title":"Reversal of hypercoagulability in patients with HCV-related cirrhosis after treatment with direct-acting antivirals","volume":"38","author":"Russo","year":"2018","journal-title":"Liver Int"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"660","DOI":"10.1016\/j.jhep.2022.03.009","article-title":"Increased platelet aggregation in patients with decompensated cirrhosis indicates higher risk of further decompensation and death","volume":"77","author":"Zanetto","year":"2022","journal-title":"J Hepatol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"100493","DOI":"10.1016\/j.jhepr.2022.100493","article-title":"Global hemostatic profiling in patients with decompensated cirrhosis and bacterial infections","volume":"4","author":"Zanetto","year":"2022","journal-title":"JHEP Rep"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1327","DOI":"10.1002\/hep.31443","article-title":"Acute kidney injury in decompensated cirrhosis is associated with both hypo-coagulable and hyper-coagulable features","volume":"72","author":"Zanetto","year":"2020","journal-title":"Hepatology"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"939","DOI":"10.3760\/cma.j.cn112138-20230424-00210","article-title":"Expert consensus on critical values of hemorrhagic diseases (2023 version)","volume":"62","year":"2023","journal-title":"Zhonghua Nei Ke Za Zhi"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1006","DOI":"10.1055\/a-1667-7293","article-title":"Prevalence of bleeding and thrombosis in critically ill patients with chronic liver disease","volume":"122","author":"Ow","year":"2022","journal-title":"Thromb Haemost"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"2181","DOI":"10.1136\/gutjnl-2017-314641","article-title":"Development of diagnostic criteria and a prognostic score for hepatitis B virus-related acute-on-chronic liver failure","volume":"67","author":"Wu","year":"2018","journal-title":"Gut"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1159\/000500408","article-title":"Safety and efficacy of regional citrate anticoagulation during plasma adsorption plus plasma exchange therapy for patients with acute-on-chronic liver failure: a pilot study","volume":"48","author":"Ma","year":"2019","journal-title":"Blood Purif"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"896","DOI":"10.3760\/cma.j.cn501113-20200609-00304","article-title":"Management strategies for chronic liver disease-related thrombocytopenia","volume":"29","author":"Qian","year":"2021","journal-title":"Zhonghua Gan Zang Bing Za Zhi"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1956","DOI":"10.1056\/NEJMoa2214322","article-title":"Platelet transfusion before CVC placement in patients with thrombocytopenia","volume":"388","author":"van Baarle","year":"2023","journal-title":"N Engl J Med"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1381386","DOI":"10.3389\/fmed.2024.1381386","article-title":"Outcome of patients with different stages of acute-on-chronic liver failure treated with artificial liver support system","volume":"11","author":"Ma","year":"2024","journal-title":"Front Med Lausanne"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1016\/j.cgh.2015.09.029","article-title":"Thrombocytopenia is associated with multi-organ system failure in patients with acute liver failure","volume":"14","author":"Stravitz","year":"2016","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"301","DOI":"10.3760\/cma.j.cn121430-20190909-00069","article-title":"Clinical predictive value of short-term dynamic changes in platelet counts for prognosis of sepsis patients in intensive care unit: a retrospective cohort study in adults","volume":"32","author":"Zhou","year":"2020","journal-title":"Zhonghua Wei Zhong Bing Ji Jiu Yi Xue"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"e97286","DOI":"10.1371\/journal.pone.0097286","article-title":"Decreased platelet count in patients receiving continuous veno-venous hemofiltration: a single-center retrospective study","volume":"9","author":"Wu","year":"2014","journal-title":"PLoS One"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1097\/MAT.0000000000000637","article-title":"Hematologic disorders in children with continuous renal replacement therapies","volume":"64","author":"Fabra","year":"2018","journal-title":"ASAIO J"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1931","DOI":"10.1002\/hep.29694","article-title":"Bleeding complications in acute liver failure","volume":"67","author":"Stravitz","year":"2018","journal-title":"Hepatology"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"740","DOI":"10.3324\/haematol.2014.118075","article-title":"Risk of bleeding and use of platelet transfusions in patients with hematologic malignancies: recurrent event analysis","volume":"100","author":"Stanworth","year":"2015","journal-title":"Haematologica"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"755","DOI":"10.5009\/gnl19131","article-title":"Child-Pugh B or C cirrhosis increases the risk for bleeding following Colonoscopic polypectomy","volume":"14","author":"Soh","year":"2020","journal-title":"Gut Liver"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1016\/j.ejim.2010.02.001","article-title":"The coagulopathy of chronic liver disease: is there a causal relationship with bleeding? No","volume":"21","author":"Tripodi","year":"2010","journal-title":"Eur J Intern Med"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1016\/j.jhep.2022.09.005","article-title":"Severity of systemic inflammation is the main predictor of ACLF and bleeding in individuals with acutely decompensated cirrhosis","volume":"78","author":"Zanetto","year":"2023","journal-title":"J Hepatol"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1097\/00003246-199501000-00018","article-title":"Removal of platelet-activating factor in experimental continuous arteriovenous hemofiltration","volume":"23","author":"Ronco","year":"1995","journal-title":"Crit Care Med"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1111\/1744-9987.12240","article-title":"Evaluation of plasma exchange and continuous veno-venous hemofiltration for the treatment of severe avian influenza a (H7N9): a cohort study","volume":"19","author":"Liu","year":"2015","journal-title":"Ther Apher Dial"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"127","DOI":"10.4240\/wjgs.v15.i2.127","article-title":"Minimum platelet count threshold before invasive procedures in cirrhosis: evolution of the guidelines","volume":"15","author":"Biolato","year":"2023","journal-title":"World J Gastrointest Surg"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1111\/bjh.14423","article-title":"Guidelines for the use of platelet transfusions","volume":"176","author":"Estcourt","year":"2017","journal-title":"Br J Haematol"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"477","DOI":"10.1016\/j.jceh.2020.04.011","article-title":"Indian National Association for the study of liver consensus statement on acute liver failure (Part-2): management of acute liver failure","volume":"10","author":"Anand","year":"2020","journal-title":"J Clin Exp Hepatol"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1718780\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T06:40:17Z","timestamp":1769668817000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1718780\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,29]]},"references-count":34,"alternative-id":["10.3389\/fmed.2026.1718780"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1718780","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,29]]},"article-number":"1718780"}}