Serum Indirect Bilirubin Level Affects Platelet Count And Curative Effect In Patients With ET And PV

ObjectiveInflammatory microenvironment promotes the occurrence and development of MPN.Inflammation activates platelets,white blood cells and endothelial cells to promote thrombosis;in addition,chronic inflammation increases genetic instability,promotes clonal expansion of hematopoietic stem cells,and promotes MPN from the early stage of the disease to the stage of bone marrow fibrosis with failure.Indirect bilirubin can activate PPARa,inhibit NF-κB signal pathway,or inhibit complement activation and reduce macrophages,neutrophils and inflammatory factors through classical pathways,which play a role in anti-tumor and anti-inflammation.The relationship between bilirubin and inflammation,inflammation and tumor(including solid tumor and hematological tumor),bilirubin and solid tumor has been widely studied,but the research on the relationship between bilirubin and hematological tumor is still in a blank.The purpose of this study was to analyze the relationship between serum indirect bilirubin and platelet count in patients with primary thrombocythemia(ET)and polycythemia vera(PV),and to evaluate the predictive value of serum indirect bilirubin(IBIL)in the response to ET treatment,and to explore whether indirect bilirubin can be used as an independent factor affecting the prognosis of ET.At the same time,we wonder whether the research on bilirubin can provide a new idea for us to treat MPN based on the effect of bilirubin on inflammation and inflammation on MPN.Materials and MethodsAccording to the entry and excretion criteria,317 patients with PV and ET diagnosed in our hospital from 2014-09 to 2021-09 were retrospectively analyzed after excluding patients with hepatitis,hepatitis virus carriers and patients with abnormal liver function,anemia and use of drugs affecting bilirubin.SPSS26.0 and R4.1.1 software was used for statistical analysis.Spearman correlation analysis and multiple linear regression analysis were used to analyze the relationship between bilirubin and platelets.Univariate binary Logistic regression and multivariate binary Logistic regression were used to determine the independent factors affecting treatment response.Receiver characteristic work(ROC)curve and clinical decision-making(DCA)curve were used to test the effectiveness and clinical practicability of bilirubin in predicting treatment response.The missing data were deleted by simple deletion method,P<0.05,which was considered to be statistically significant.Results1)in ET and PV,there was a negative correlation between PLT and IBIL when PLT<1000 × 10^9 pixel L(r=-0.415,P<0.415),and there was also a negative correlation between PLT and IBIL in ET and PV subgroups(R1=-0.372).Multiple linear regression analysis further showed that there was a linear relationship between IBIL and PLT(B=-13.412,P<0.001)when platelet count was less than 1000 × 10^9 in ET and PV.2)The results of univariate and multivariate Logistic regression analysis showed that indirect bilirubin was the protective factor of ET treatment response(OR=0.599,95%CI=0.281-0.975(P<0.001).The cutoff value 6.34umol/L was obtained from the ROC curve(sensitivity=0.793%,specificity=0.765%,P<0.001).According to the cutoff value,univariate Logistic regression showed that the patients with indirect bilirubin higher than 6.34umolphama had better curative effect(OR=3.771,95%CI=1.047-13.581,P<0.001).According to the independent influencing factors of treatment response identified in this study,the DCA curve was drawn and the prognostic factors included in the guidelines were drawn DCA curve.Our model is slightly better(AUDC value:0.0129 vs 0.0088;net benefit range 0.00099～0.07594 vs-0.00996～0.07634),and has clinical practicability.ConclusionsThe level of indirect bilirubin in the body has a negative effect on the platelet count of ET and PV,but the effect is weak and limited.Our study supports indirect bilirubin as a biomarker of medium-term efficacy in patients with ET,perhaps indirect bilirubin can also be a protective factor for its prognosis,but the impact on the prognosis needs further research to prove.Based on the effect of bilirubin on inflammation and inflammation on MPN,it may provide us with a new way to treat MPN so that MPN patients will benefit more.However,all of these need more in-depth research.