Mean Platelet Volume As A Potential Prognostic Marker in Patients With Decompensated Liver Disease: A Prospective Observational Study

Abstract

Background: Anemia, cytopenias and deranged coagulation are common in decompensated liver disease, yet the platelet indices reported with every automated blood count are rarely used for risk assessment. Mean platelet volume (MPV) reflects platelet size and turnover and is available without extra cost. This study examined whether MPV is related to thrombocytopenia and coagulopathy in patients with decompensated liver disease.

Methods: In this prospective observational study, 60 consecutive adults with decompensated chronic liver disease were enrolled in the Department of General Medicine of a tertiary teaching hospital in Chennai, India, between May 2024 and December 2025. Complete blood count with MPV, peripheral smear, liver and renal function tests, prothrombin time (PT), international normalized ratio (INR), fibrinogen and abdominal ultrasonography were recorded. Patients were grouped by MPV as <9, 9–11 and >11 fL. Categorical associations were tested with the chi-square test and the chi-square test for linear trend.

Results: Men formed 70.0% of the cohort and alcohol was the leading cause (53.3%). Anemia was present in 46 (76.7%), thrombocytopenia in 40 (66.7%) and leukopenia in 22 (36.7%) patients; PT was prolonged in 34 (56.7%). Thrombocytopenia rose from 42.9% in the lowest MPV band to 68.8% and 85.7% in the middle and highest bands (p for trend = 0.017). Coagulopathy increased in the same direction (42.9%, 56.3% and 71.4%), though not significantly (p for trend = 0.130). Anemia was more frequent in patients with coagulopathy (88.2% vs 61.5%; p = 0.015).

Conclusion: Higher MPV accompanied a greater frequency of thrombocytopenia in decompensated liver disease. MPV may help identify patients with more marked platelet abnormalities, but its prognostic value needs confirmation in larger outcome-based studies that include Child-Pugh and MELD scores.