Prevalence and Clinical Significance of Portal Vein Thrombosis in Patients With Cirrhosis and Acute Decompensation.

Abstract

BACKGROUND & AIMS:

Portal vein thrombosis (PVT) is a common and serious complication in patients with cirrhosis. However, little is known about PVT in patients with cirrhosis and acute decompensation (AD). We investigated the prevalence and clinical significance of PVT in nonmalignant patients with cirrhosis and AD.

METHODS:

We performed a retrospective study of 2 cohorts of patients with acute exacerbation of chronic liver disease who participated in the Chinese AcuTe on CHronic LIver FailurE study, established by the Chinese Chronic Liver Failure Consortium, from January 2015 through December 2016 (n = 2600 patients) and July 2018 through January 2019 (n = 1370 patients). We analyzed data on the prevalence, clinical manifestations, and risk factors of PVT from 2826 patients with cirrhosis, with and without AD.

RESULTS:

The prevalence of PVT in patients with cirrhosis and AD was 9.36%, which was significantly higher than in patients with cirrhosis without AD (5.24%) (P = .04). Among patients with cirrhosis and AD, 63.37% developed PVT recently (the first detected PVT with no indication of chronic PVT). Compared with patients without PVT, a significantly higher proportion of patients with PVT had variceal bleeding (47.33% vs 19.63%; P < .001) and patients with PVT had a significantly higher median serum level of D-dimer (2.07 vs 1.25; P < .001). Splenectomy and endoscopic sclerotherapy were independent risk factors for PVT in patients with cirrhosis and AD. The 1-year mortality rate did not differ significantly between patients with vs without PVT.

CONCLUSIONS:

In an analysis of data from 2826 patients with cirrhosis, a significantly higher proportion of those with AD had PVT than those without AD. PVT was associated with increased variceal bleeding, which would increase the risk for AD. Strategies are needed to prevent PVT in patients with cirrhosis, through regular screening, to reduce portal hypertension. ClinicalTrials.gov no: NCT02457637 and NCT03641872.

• Authors: Yan Zhang, Bao-Yan Xu, Xian-Bo Wang, Xin Zheng, Yan Huang, Jinjun Chen, Zhong-Ji Meng, Yan-Hang Gao, Zhi-Ping Qian, Feng Liu, Xiao-Bo Lu, Yu Shi, Jia Shang, Hai Li, Shao-Yang Wang, Shan Yin, Shu-Ning Sun, Yi-Xin Hou, Yan Xiong, Jun Chen, Bei-Ling Li, Qing Lei, Na Gao, Liu-Juan Ji, Jing Li, Fang-Rong Jie, Rui-Hong Zhao, Jun-Ping Liu, Tao-Fa Lin, Liu-Ying Chen, Wen-Ting Tan, Qun Zhang, Cong-Cong Zou, Ze-Bing Huang, Xiu-Hua Jiang, Sen Luo, Chun-Yan Liu, Yu-Yi Zhang, Tao Li, Hao-Tang Ren, Shi-Jin Wang, Guo-Hong Deng, Shu-E Xiong, Xiao-Xiao Liu, Chen Wang, Wei Yuan, Wen-Yi Gu, Liang Qiao, Tong-Yu Wang, Dan-Dan Wu, Fu-Chen Dong, Hai Li, Jing Hua
• Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (Clin Gastroenterol Hepatol) Vol. 18 Issue 11 Pg. 2564-2572.e1 (10 2020) ISSN: 1542-7714 [Electronic] United States
• PMID: 32109631 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2020 AGA Institute. Published by Elsevier Inc. All rights reserved.

Topics

• Esophageal and Gastric Varices (complications, epidemiology, pathology)
• Gastrointestinal Hemorrhage (pathology)
• Humans
• Liver Cirrhosis (complications, pathology)
• Portal Vein (pathology)
• Prevalence
• Retrospective Studies
• Venous Thrombosis (complications, epidemiology, pathology)