Premium
Incidence, predictive factors and clinical significance of development of portal vein thrombosis in cirrhosis: A prospective study
Author(s) -
Noronha Ferreira Carlos,
Marinho Rui T.,
CortezPinto Helena,
Ferreira Paula,
Dias Margarida S.,
Vasconcelos Mariana,
Alexandrino Paula,
Serejo Fátima,
Pedro Ana Júlia,
Gonçalves Afonso,
Palma Sónia,
Leite Inês,
Reis Daniela,
Damião Filipe,
Valente Ana,
Xavier Brito Leonor,
Baldaia Cilenia,
Fatela Narcisa,
Ramalho Fernando,
Velosa José
Publication year - 2019
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.14121
Subject(s) - medicine , cirrhosis , portal vein thrombosis , gastroenterology , decompensation , incidence (geometry) , prospective cohort study , cumulative incidence , surgery , transplantation , physics , optics
Background and aims The role of portal vein thrombosis (PVT) in the natural history of cirrhosis is controversial. There are few prospective studies validating risk factors for development of PVT. We analysed the incidence, factors associated with PVT development and its influence on cirrhosis decompensations and orthotopic liver transplant (OLT)‐free survival. Methods In this prospective observational study between January 2014 and March 2019, 445 consecutive patients with chronic liver disease were screened and finally 241 with cirrhosis included. Factors associated with PVT development and its influence on cirrhosis decompensations and OLT‐free survival by time dependent covariate coding were analysed. Results Majority of patients belonged to Child‐Pugh class A 184 (76.3%) and the average MELD score was 10 ± 5. Previous cirrhosis decompensations occurred in 125 (52.1%), 63 (26.1%) were on NSBB and 59 (27.2%) had undergone banding for bleeding prophylaxis. Median follow‐up was 29 (1‐58) months. Cumulative incidence of PVT was 3.7% and 7.6% at 1 and 3 years. Previous decompensation of cirrhosis and low platelet counts but not NSBB independently predicted the development of PVT. During follow‐up, 82/236 (34.7%) patients developed cirrhosis decompensations. OLT‐free survival was 100% and 82.8% at 3 years, with and without PVT respectively. MELD score, but not PVT, independently predicted cirrhosis decompensations (HR 1.14; 95%CI:1.09‐1.19) and OLT‐free survival (HR 1.16;95%CI:1.11‐1.21). Conclusion Previous decompensations of cirrhosis and thrombocytopenia predict PVT development in cirrhosis suggesting a pathophysiologic role for severity of portal hypertension. PVT development did not independently predict cirrhosis decompensations or lower OLT‐free survival.