Risk factors for portal vein thrombosis or venous thromboembolism in a large cohort of hospitalized cirrhotic patients

Abstract

Background Portal vein thrombosis (PVT) and venous thromboembolism (VTE) are fearsome complications of liver cirrhosis. Objectives To assess the prevalence and the main risk factors for venous thrombotic complications in hospitalized cirrhotic patients. Patients/methods We retrospectively reviewed electronic administrative discharge data of 19461 cirrhotic patients hospitalized over a 35-year period; univariate and multivariate logistic regression was used to asses risk factors for PVT or VTE and their impact on hospital stay and mortality. Results 382 out of 7445 patients (5.1%) were diagnosed with PVT and 95 (1.3%) with VTE. Liver cirrhosis complications were observed in 45% of patients. Hepatic encephalopathy (HE) (OR 13.88 [10.76–17.98] p < 0.0001), endoscopic signs of portal hypertension (OR 1.33 [1.02–1.75] p = 0.02), hepatocellular carcinoma (HCC) (OR 4.59 [3.6–5.84] p < 0.0001), diabetes (OR 1.68 [1.27–2.22] p = 0.0001), abdominal surgery/invasive procedures (OR 2.03 [1.56–2.64] p < 0.0001) emerged as independent predictors of PVT. Higher risk of VTE was observed in patients with HE (OR 3.21 [1.78–5.79] p < 0.0001), HCC (OR 1.98 [1.23–3.19] p = 0.002) or other tumors (OR 2.48 [1.42–4.32] p = 0.001), acute illnesses (infections OR 3.01 [1.84–5.05] p = 0.0001; cardiac/respiratory insufficiency OR 2.4 [1.27–4.53] p = 0.003; acute myocardial infarction/stroke OR 7.86 [1.76–35.12] p = 0.003). VTE was the only independent predictor of in-hospital mortality (OR 4.45 [1.05–18.81] p = 0.042). Conclusions Liver disease complications related to portal hypertension, HCC or other tumors, diabetes, acute illnesses (i.e. infections, cardiac/pulmonary insufficiency, acute myocardial infarction/stroke) and abdominal interventions are associated with increased risk of PVT or VTE in hospitalized cirrhotic patients, and should be considered to define personalized preemptive approaches.

Thromboprophylaxis for venous thromboembolism prevention in hospitalized patients with cirrhosis: Guidance from the SSC of the ISTH

“…22 A retrospective review of a large cohort of hospitalized patients with cirrhosis (n = 7445) reported 5.1% diagnosed with PVT and 1.3% VTE during hospitalization. 23 Hepatic encephalopathy (OR 14.0, 95% CI 10.8-14.1) and portal hypertensive changes at endoscopy (OR 1.3, 95% CI 1.03-1.8) were identified as independently associated with PVT, suggesting the risk increases in parallel with severity of liver disease. Additional risk factors included malignancy, diabetes, and abdominal surgery/invasive procedures.…”

“…Prospective studies of PVT in patients with cirrhosis report an incidence ranging from 3.7%–24.5% at 1 year, with higher rates seen in cohorts including increased numbers of patients with decompensated disease 22 . A retrospective review of a large cohort of hospitalized patients with cirrhosis ( n = 7445) reported 5.1% diagnosed with PVT and 1.3% VTE during hospitalization 23 . Hepatic encephalopathy (OR 14.0, 95% CI 10.8–14.1) and portal hypertensive changes at endoscopy (OR 1.3, 95% CI 1.03–1.8) were identified as independently associated with PVT, suggesting the risk increases in parallel with severity of liver disease.…”

Portal vein thrombosis in liver cirrhosis: An updated overview

“…The lifetime cumulative prevalence of PVT is as little as 1% in the general population 2 . In hospitalized cirrhotic patients, two large retrospective studies, including 3,045,098 and 7445 cases, respectively, showed that the prevalence of PVT is 1.5%–5% 3,4 . However, the prevalence of PVT is highly variable at different stages of liver disease (patients with compensated, decompensated, acute decompensated cirrhosis, and liver transplantation [LT], 10%, 17%, 9%, and 2%–26%, respectively) 5–7 .…”

Development and validation of a coagulation-related genes prognostic model for hepatocellular carcinoma

“…Studies have found that the risk of venous thromboembolism (VTE) in tumor patients is 9 times higher than in the general population [4], which seriously affects the survival rate of tumor patients. The incidence of portal vein thrombosis (PVT) caused by HCC is as high as 40% [5]. PVT is an indicator of the aggressiveness of HCC and can be used as an important predictor of the poor prognosis of HCC patients [6].…”