Impact of Asymptomatic Superior Mesenteric Vein Thrombosis on the Outcomes of Patients with Liver Cirrhosis

Abstract

Background The impact of asymptomatic superior mesenteric vein (SMV) thrombosis on the outcomes of cirrhotic patients remains uncertain. Methods Nonmalignant cirrhotic patients who were consecutively admitted between December 2014 and September 2021 and underwent contrast-enhanced computed tomography/magnetic resonance imaging scans were screened. Portal venous system thrombosis (PVST) was identified. Death and hepatic decompensation were the outcomes of interest. Nelson–Aalen cumulative risk curve analysis and competing risk regression analysis were performed to evaluate the impact of asymptomatic SMV thrombosis and portal vein thrombosis (PVT) on the outcomes. Results Overall, 475 patients were included, of whom 67 (14.1%) had asymptomatic SMV thrombosis, 95 (20%) had PVT, and 344 (72.4%) did not have any PVST. Nelson–Aalen cumulative risk curve analyses showed that the cumulative incidences of death (p = 0.653) and hepatic decompensation (p = 0.630) were not significantly different between patients with asymptomatic SMV thrombosis and those without PVST, but the cumulative incidences of death (p = 0.021) and hepatic decompensation (p = 0.004) were significantly higher in patients with PVT than those without PVST. Competing risk regression analyses demonstrated that asymptomatic SMV thrombosis was not a significant risk factor for death (subdistribution hazard ratio [sHR] = 0.89, p = 0.65) or hepatic decompensation (sHR = 1.09, p = 0.63), but PVT was a significant risk factor for death (sHR = 1.56, p = 0.02) and hepatic decompensation (sHR = 1.50, p = 0.006). These statistical results remained in competing risk regression analyses after adjusting for age, sex, and Child–Pugh score. Conclusions Asymptomatic SMV thrombosis may not influence the outcomes of cirrhotic patients. The timing of intervention for asymptomatic SMV thrombosis in liver cirrhosis should be further explored.

Association of C-type lectin-like receptor 2 and galectin-1 with portal vein system thrombosis in HBV-related liver cirrhosis

“…HBV-related liver cirrhosis would be defined, if cirrhotic patients were diagnosed with HBV infection or had positive hepatitis B surface antigens. Based on the contrast-enhanced CT/MRI imaging, PVST was defined as thrombosis within portal venous system vessels, including left portal vein, right portal vein, main portal vein (MPV), superior mesenteric vein (SMV), splenic vein (SV), or the confluence of SMV and SV ( 20 ). Based on the most severe thrombosis in any vessel of the portal venous system, the degree of thrombosis was divided into mural thrombosis (<50%), partial thrombosis (50–80%), complete thrombosis (>80%), and fibrotic cord ( 20 ).…”

Understanding the pathogenesis of portal vein thrombosis in liver cirrhosis: We are still on the way

“…It is very necessary for physicians to judge the presence and risk of PVT due to its negative impact on the outcomes of cirrhotic patients. 2,3 Specifically, acute symptomatic porta-mesenteric vein thrombosis can result in intestinal necrosis, necessitating surgical interventions; and occlusive PVT can aggravate the severity of portal hypertension, increasing the risk of esophageal variceal bleeding and other portal hypertension related complications in patients with liver cirrhosis. 4 On the other hand, identification of cirrhotic patients at a high risk of developing PVT is also crucial to initiate prophylactic and therapeutic strategy of PVT and further improve the prognosis.…”

“…According to the findings of a recent meta‐analysis, 1 the pooled prevalence of PVT in patients with liver cirrhosis is 13.92%, and the pooled incidence is 10.42%. It is very necessary for physicians to judge the presence and risk of PVT due to its negative impact on the outcomes of cirrhotic patients 2,3 . Specifically, acute symptomatic porta‐mesenteric vein thrombosis can result in intestinal necrosis, necessitating surgical interventions; and occlusive PVT can aggravate the severity of portal hypertension, increasing the risk of esophageal variceal bleeding and other portal hypertension related complications in patients with liver cirrhosis 4 .…”