Background and aims

The association between prognosis of variceal bleeding and portal vein thrombosis (PVT) is unclear. In this multicentre study, we determined the effect of PVT on rebleeding and mortality in patients with acute variceal bleeding (AVB) after oesophageal variceal band ligation (EVL).

Methods

Cirrhotic patients with AVB who had undergone EVL were included. The patients were allocated to either the PVT group or the control cirrhotic group (CCG) based on the presence or absence of PVT. One-year rebleeding episodes and mortality after EVL were recorded.

Results

A total of 218 cirrhotic patients with AVB from 3 centres were included. Patients with PVT had a higher rate of 14-day and 6-week rebleeding than those without PVT (14-day: 8.26% vs. 1.83%, p = 0.03; 6-week: 11.92% vs. 1.83%, p = 0.003). The rates of 5-day failure (3.67% vs. 0.92%, p = 0.175), 1-year rebleeding (21.10% vs. 20.18%, p = 0.867), and 14-day, 6-week, and 1-year mortality were similar between the groups (14-day: 3.67% vs. 0.92%, p = 0.175; 6-week: 3.67% vs. 0.92%, p = 0.175; 1-year: 3.67% vs. 1.83%, p = 0.408). The Child–Pugh class [p = 0.022, hazard ratio (HR): 1.453; 95% confidence interval (CI) 1.056–1.998], PVT (p = 0.050, HR: 4.622, 95% CI 0.999–21.395), albumin < 30 g/L (p = 0.023, HR: 5.886, 95% CI 1.272–27.245), and number of bands (p = 0.010, HR: 1.207, 95% CI 1.046–1.393) were identified as the predictors for 14-day rebleeding; the multivariate analysis revealed only the number of bands (p = 0.009, HR: 1.247, 95% CI 1.056–1.473) as the independent factor. PVT (p = 0.012, HR: 6.732, 95% CI 1.519–29.835) and albumin < 30 g/L (p = 0.027, HR: 3.643, 95% CI 1.160–11.441) were identified as predictors for 6-week rebleeding; however, only PVT (p = 0.015, HR: 6.380, 95% CI 1.427–28.515) was found to be the independent factor in the multivariate analysis. Further analysis showed that superior mesenteric vein (SMV) thrombosis is the only risk factor predicting 6-week rebleeding in patients with PVT (p = 0.032, HR: 3.405, 95% CI 1.112–10.429).

Conclusions

PVT was associated with high 14-day and 6-week rebleeding in patients after EVL. SMV thrombosis was the only risk factor for 6-week rebleeding in patients with PVT. High albumin levels may serve as a protective factor for the 14-day and 6-week rebleeding risk. PVT was not responsible for mortality after EVL during 1-year follow-up.

中文翻译：

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食管静脉曲张套扎术后 14 天和 6 周高再出血与门静脉血栓形成相关：一项回顾性、多中心、巢式病例对照研究

背景和目标

静脉曲张出血的预后与门静脉血栓形成 (PVT) 之间的关系尚不清楚。在这项多中心研究中，我们确定了 PVT 对食管静脉曲张套扎 (EVL) 后急性静脉曲张出血 (AVB) 患者再出血和死亡率的影响。

方法

包括接受过 EVL 的 AVB 肝硬化患者。根据是否存在 PVT，将患者分配到 PVT 组或对照肝硬化组 (CCG)。记录了 EVL 后一年的再出血事件和死亡率。

结果

共纳入来自 3 个中心的 218 名 AVB 肝硬化患者。PVT 患者的 14 天和 6 周再出血率高于没有 PVT 的患者（14 天：8.26% 对 1.83%，p  = 0.03；6 周：11.92% 对 1.83%，p  = 0.003 ）。5 天失败率（3.67% 对 0.92%，p  = 0.175）、1 年再出血率（21.10% 对 20.18%，p  = 0.867）和 14 天、6 周和 1 年两组间的死亡率相似（14 天：3.67% 对 0.92%，p  = 0.175；6 周：3.67% 对 0.92%，p  = 0.175；1 年：3.67% 对 1.83%，p  = 0.408）。Child–Pugh 类 [ p  = 0.022，风险比 (HR)：1.453；95% 置信区间 (CI) 1.056–1.998], PVT (p  = 0.050, HR: 4.622, 95% CI 0.999–21.395), 白蛋白 < 30 g/L ( p  = 0.023, HR: 5.886, 95% CI 1.272–27.245), 条带数 ( p  = 0.010, HR: 1.207, 95% CI 1.046–1.393) 被确定为 14 天再出血的预测因子；多变量分析仅显示带数（p  = 0.009，HR：1.247，95% CI 1.056-1.473）作为独立因素。PVT ( p  = 0.012, HR: 6.732, 95% CI 1.519–29.835) 和白蛋白 < 30 g/L ( p  = 0.027, HR: 3.643, 95% CI 1.160–11.441) 被确定为 6 周再出血的预测因子；然而，只有 PVT ( p = 0.015, HR: 6.380, 95% CI 1.427–28.515) 被发现是多变量分析中的独立因素。进一步分析表明，肠系膜上静脉 (SMV) 血栓形成是预测 PVT 患者 6 周再出血的唯一危险因素（p  = 0.032，HR：3.405，95% CI 1.112-10.429）。

结论

PVT 与 EVL 后患者的高 14 天和 6 周再出血相关。SMV 血栓形成是 PVT 患者 6 周再出血的唯一危险因素。高白蛋白水平可作为 14 天和 6 周再出血风险的保护因素。在 1 年的随访期间，PVT 与 EVL 后的死亡率无关。