Portal vein thrombosis increases short-term mortality among hospitalized patients with cirrhosis in a global cohort.
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Choudhury Ashok, Silvey Scott, Wong Florence, Kamath Patrick S, George Jacob, Idilman Ramazan, Topazian Mark, Torre Aldo, Álvares-da-Silva Mário Reis, Xie Qing, Hayes Peter, Seto Wai Kay, Sarin Shiv K, Cordova-Gallardo Jacqueline, Venkatachalapathy Suresh Vasan, Wang Xiangmei, Zitelli Patricia, Leung Hak-Keith, Belimi Hibat Allah, Xu Bin, Félix-Tellez Francisco, Livingstone Robert, Lu Mingqin, Peng Feng, Haktaniyan Busra, Lun Liou Wei, Shalimar, Goel Ashish, Reddy K Rajender, Zheng Katina, Kumar Surender, Rela Mohammad, Jhaveri Ajay, Goodheart Richard, Dinçer Dinç, Thanapirom Kessarin, Fisseha Henok, Wang Yue, Hueso Sarai Gonzalez, Made Lilian Torres, Guedes Paula, Rajoriya Neil, Li Tao, Gofton Cameron, Elangovan Harendran, MacQuillan Gerry, Garrido Trevino Luis, Wang Wei, Riordan Stephen, Praharaj Dibyalochan, Kulkarni Anand V, Faisal Nabiha, Yapici Hasan Basri, Vargas Hugo, Katchman Helena, Hérnandez José Luis Pérez, Guo Feng, Lohoues Marie Jeanne, Duseja Ajay, Berhane Kaleb A, Hakem Ahmed, Deng Huan, Liu Chenghai, Biggins Scott W, Patwa Yashwi Haresh Kumar, Sonavane Amey, Schultheiß Michael, Tandon Punita, Kumar Shiva, Thuluvath Paul, Tang Hong, Wang Xinrui, Gibson Robert, Gadano Adrián, Marwan Ewan, Zekry Amany, Karasu Zeki, Mostafa Alaa, Arora Anil, Zhang Ningping, Cai Cailian, Valsan Arun, Forrest Ewan, Xu Qinglang, Zheng Xin, Li Hai, Xian Yongchao, Keaveny Andrew, Gao Zhiliang, Verna Elizabeth, Wong Yu Jun, Duduyemi Babatunde, Bush Brian J, Bajaj Jasmohan S, CLEARED Consortium
Аннотация
METHODS: The multinational CLEARED consortium prospectively enrolled adults with cirrhosis admitted non-electively after consent. Patients were followed during hospitalization and 30 days post-discharge. Radiologically diagnosed PVT was analyzed in relation to demography, etiology, clinical features, hospital course, and 30-day outcomes, including mortality.
RESULTS: Among 7,721 patients, etiologies included alcohol related (41.3%), MASH/cryptogenic (24.4%), hepatitis B (19.4%), and hepatitis C (11.3%). PVT was present in 773 patients (10.0%). Prevalence was higher in MASH/cryptogenic and viral cirrhosis compared with alcohol etiology (11.9%, 11.7% vs. 7.3%). Alcohol etiology was associated with lower odds of PVT [OR 0.64 (95% CI 0.5-0.8), p<0.001]. PVT was more common in patients with diabetes (37.4% vs. 28.9%) and in high-income countries (all p<0.001). Independent predictors of PVT included MASH/cryptogenic etiology [OR 1.59 (95% CI 1.2-2.1), p<0.01], prior portal hypertension-related complications (ascites, variceal bleeding, overt HE, hydrothorax), and non-selective beta-blocker use. PVT associated with higher rates of AKI, grade 3-4 hepatic encephalopathy, 30-day readmission, and liver transplantation (all p<0.05). Thirty-day mortality was higher in patients (22.1% vs. 18.0%; p=0.001), and PVT independently predicted mortality (OR 1.5; 95% CI 1.1-1.9; p<0.001).
CONCLUSIONS: PVT affects one in ten patients in a global inpatient cirrhosis cohort, and independently predicts short-term mortality and major complications, identifying a high-risk subgroup requiring intensified inpatient and post-discharge care.