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

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Prevalence and Clinical Significance of Portal Vein Thrombosis in Patients With Cirrhosis and Acute Decompensation.
Clinical Gastroenterology and Hepatology ( IF 12.6 ) Pub Date : 2020-02-25 , DOI: 10.1016/j.cgh.2020.02.037
Yan Zhang ₁ , Bao-Yan Xu ₂ , Xian-Bo Wang ₃ , Xin Zheng ₄ , Yan Huang ₅ , Jinjun Chen ₆ , Zhong-Ji Meng ₇ , Yan-Hang Gao ₈ , Zhi-Ping Qian ₉ , Feng Liu ₁₀ , Xiao-Bo Lu ₁₁ , Yu Shi ₁₂ , Jia Shang ₁₃ , Hai Li ₁₄ , Shao-Yang Wang ₁₅ , Shan Yin ₁ , Shu-Ning Sun ₂ , Yi-Xin Hou ₃ , Yan Xiong ₄ , Jun Chen ₅ , Bei-Ling Li ₆ , Qing Lei ₇ , Na Gao ₈ , Liu-Juan Ji ₉ , Jing Li ₁₀ , Fang-Rong Jie ₁₁ , Rui-Hong Zhao ₁₂ , Jun-Ping Liu ₁₃ , Tao-Fa Lin ₁₅ , Liu-Ying Chen ₁ , Wen-Ting Tan ₂ , Qun Zhang ₃ , Cong-Cong Zou ₄ , Ze-Bing Huang ₅ , Xiu-Hua Jiang ₆ , Sen Luo ₇ , Chun-Yan Liu ₈ , Yu-Yi Zhang ₉ , Tao Li ₁₀ , Hao-Tang Ren ₁₂ , Shi-Jin Wang ₁ , Guo-Hong Deng ₂ , Shu-E Xiong ₄ , Xiao-Xiao Liu ₅ , Chen Wang ₇ , Wei Yuan ₉ , Wen-Yi Gu ₁ , Liang Qiao ₁ , Tong-Yu Wang ₁ , Dan-Dan Wu ₁ , Fu-Chen Dong ₁ , Hai Li ₁ , Jing Hua ₁

Affiliation

Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Chinese Ministry of Health (Shanghai Jiao Tong University), Shanghai, China.
Department of Infectious Diseases, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.
Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China.
Department of Infectious Diseases, Hunan Key Laboratory of Viral Hepatitis, Xiangya Hospital, Central South University, Hunan, China.
Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Department of Infectious Diseases, Taihe Hospital, Hubei University of Medicine, Hubei, China.
Department of Hepatology, The First Hospital of Jilin University, Jilin, China.
Department of Liver Intensive Care Unit, Shanghai Public Health Clinical Centre, Fudan University, Shanghai, China.
Department of Infectious Diseases and Hepatology, The Second Hospital of Shandong University, Jinan, China.
Infectious Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China.
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Infectious Diseases, Henan Provincial People's Hospital, Henan, China.
Department of Infectious Diseases, Affiliated Hospital of Logistics University of People's Armed Police Force, Tianjin, China.
Department of Infectious Diseases, Fuzhou General Hospital of Nanjing Military Command, Fujian, China.

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.

更新日期：2020-02-25

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