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Thromb Haemost 2022; 122(12): 2019-2029
DOI: 10.1055/s-0042-1756648
Stroke, Systemic or Venous Thromboembolism

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

Le Wang‡   *
1   Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
2   Postgraduate College, China Medical University, Shenyang, China
,
Xiaozhong Guo‡   *
1   Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
2   Postgraduate College, China Medical University, Shenyang, China
,
Zhaohui Bai‡   *
1   Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
3   Postgraduate College, Shenyang Pharmaceutical University, Shenyang, China
,
Yue Yin
1   Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
,
Shixue Xu
1   Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
2   Postgraduate College, China Medical University, Shenyang, China
,
Jiahui Pan
1   Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
3   Postgraduate College, Shenyang Pharmaceutical University, Shenyang, China
,
Andrea Mancuso
4   Medicina Interna 1, Azienda di Rilievo Nazionale ad Alta Specializzazione Civico, Di Cristina-Benfratelli, Palermo, Italy
,
Carlos Noronha Ferreira
5   Serviço De Gastrenterologia e Hepatologia, Hospital De Santa Maria-Centro Hospitalar Lisboa Norte, Lisboa, Portugal
,
Xingshun Qi
1   Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
2   Postgraduate College, China Medical University, Shenyang, China
3   Postgraduate College, Shenyang Pharmaceutical University, Shenyang, China
› Author Affiliations Funding This work was partially supported by the Science and Technology Plan Project of Liaoning Province (2015020409).
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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.

Conclusion 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.

Keywords

liver cirrhosis - mesenteric vein - portal vein - survival - thrombosis

Ethical Approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. The study was approved by the medical ethical committee of the General Hospital of Northern Theater Command [Y (2022) 003].


Patient Consent

Patients' written informed consents have been waived by the medical ethical committee due to the retrospective nature of this study.


Note

The abstract of the article has been partially presented as a poster in the European Association for the Study of the Liver (EASL) 2021 monothematic event on the “Bleeding, Thrombosis, and Vascular Liver Diseases.”


Author Contributions

Conceptualization: X.Q. Methodology: L.W. and X.Q. Formal analysis: L.W., Z.B., Y.Y., S.X., J.P., and X.Q. Data curation: L.W., Z.B., Y.Y., S.X., J.P., and X.Q. Writing --original draft: L.W., Z.B., Y.Y., S.X., J.P., and X.Q. Writing --review and editing: L.W., X.G., Z.B., Y.Y., S.X., J.P., A.M., C.N.F., and X.Q. Supervision: X.G. and X.Q. All the listed authors meaningfully participated in the study, and they have seen and approved the final manuscript.


* These authors contributed equally to this work.


Supplementary Material



Publication History

Received: 15 May 2022

Accepted: 30 June 2022

Article published online:
30 September 2022

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