PDF herunterladen
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
› Institutsangaben Funding This work was partially supported by the Science and Technology Plan Project of Liaoning Province (2015020409).
› Weitere Informationen
    Lizenzen und Reprints


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



Publikationsverlauf

Eingereicht: 15. Mai 2022

Angenommen: 30. Juni 2022

Artikel online veröffentlicht:
30. September 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Faccia M, Ainora ME, Ponziani FR. et al. Portal vein thrombosis in cirrhosis: why a well-known complication is still matter of debate. World J Gastroenterol 2019; 25 (31) 4437-4451
    CrossrefPubMedGoogle Scholar
  • 2 Mancuso A. Controversies in the management of portal vein thrombosis in liver cirrhosis. J Clin Med 2020; 9 (12) E3916
    CrossrefPubMedGoogle Scholar
  • 3 Basili S, Pastori D, Raparelli V, Violi F. Anticoagulant therapy in patients with liver cirrhosis and portal vein thrombosis: insights for the clinician. Therap Adv Gastroenterol 2018; 11: 1756284818793561
    CrossrefPubMedGoogle Scholar
  • 4 Simonetto DA, Singal AK, Garcia-Tsao G, Caldwell SH, Ahn J, Kamath PS. ACG clinical guideline: disorders of the hepatic and mesenteric circulation. Am J Gastroenterol 2020; 115 (01) 18-40
    CrossrefPubMedGoogle Scholar
  • 5 DeLeve LD, Valla DC, Garcia-Tsao G. American Association for the Study Liver Diseases. Vascular disorders of the liver. Hepatology 2009; 49 (05) 1729-1764
    CrossrefPubMedGoogle Scholar
  • 6 Hepatobiliary Disease Study Group, Chinese Society of Gastroenterology, Chinese Medical Association. Consensus for management of portal vein thrombosis in liver cirrhosis (2020, Shanghai). J Dig Dis 2021; 22 (04) 176-186
    CrossrefPubMedGoogle Scholar
  • 7 European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu. EASL clinical practice guidelines: vascular diseases of the liver. J Hepatol 2016; 64 (01) 179-202
    Google Scholar
  • 8 Wang L, Xu X, Hou Y, Shao X, Guo X, Qi X. Acute mesenteric vein thrombosis after endoscopic injection sclerotherapy for esophageal varices in a patient with liver cirrhosis. Drug Discov Ther 2019; 13 (02) 118-121
    CrossrefPubMedGoogle Scholar
  • 9 Xu X, Guo X, Wang R. et al. Low-molecular-weight heparin followed by rivaroxaban for acute occlusive portomesenteric vein thrombosis in a cirrhotic patient treated with multiple endoscopic variceal procedures. Ann Hepatol 2020; 19 (05) 573-577
    CrossrefPubMedGoogle Scholar
  • 10 Amitrano L, Guardascione MA, Brancaccio V. et al. Risk factors and clinical presentation of portal vein thrombosis in patients with liver cirrhosis. J Hepatol 2004; 40 (05) 736-741
    CrossrefPubMedGoogle Scholar
  • 11 Nery F, Chevret S, Condat B. et al; Groupe d'Etude et de Traitement du Carcinome Hépatocellulaire. Causes and consequences of portal vein thrombosis in 1,243 patients with cirrhosis: results of a longitudinal study. Hepatology 2015; 61 (02) 660-667
    CrossrefPubMedGoogle Scholar
  • 12 Cool J, Rosenblatt R, Kumar S. et al. Portal vein thrombosis prevalence and associated mortality in cirrhosis in a nationally representative inpatient cohort. J Gastroenterol Hepatol 2019; 34 (06) 1088-1092
    CrossrefPubMedGoogle Scholar
  • 13 Amitrano L, Guardascione MA, Manguso F. et al. The effectiveness of current acute variceal bleed treatments in unselected cirrhotic patients: refining short-term prognosis and risk factors. Am J Gastroenterol 2012; 107 (12) 1872-1878
    CrossrefPubMedGoogle Scholar
  • 14 Chen PH, Chen WC, Hou MC. et al. Delayed endoscopy increases re-bleeding and mortality in patients with hematemesis and active esophageal variceal bleeding: a cohort study. J Hepatol 2012; 57 (06) 1207-1213
    CrossrefPubMedGoogle Scholar
  • 15 D'Amico G, De Franchis R. Cooperative Study Group. Upper digestive bleeding in cirrhosis. Post-therapeutic outcome and prognostic indicators. Hepatology 2003; 38 (03) 599-612
    CrossrefPubMedGoogle Scholar
  • 16 Hung HH, Chang CJ, Hou MC. et al. Efficacy of non-selective β-blockers as adjunct to endoscopic prophylactic treatment for gastric variceal bleeding: a randomized controlled trial. J Hepatol 2012; 56 (05) 1025-1032
    CrossrefPubMedGoogle Scholar
  • 17 Lee SW, Lee TY, Chang CS, Ko CW, Yeh HZ, Yang SS. Independent factors associated with early outcome in Chinese cirrhotic patients after cessation of initial esophageal variceal hemorrhage. J Clin Gastroenterol 2010; 44 (06) e123-e127
    CrossrefPubMedGoogle Scholar
  • 18 Englesbe MJ, Kubus J, Muhammad W. et al. Portal vein thrombosis and survival in patients with cirrhosis. Liver Transpl 2010; 16 (01) 83-90
    CrossrefPubMedGoogle Scholar
  • 19 Berry K, Taylor J, Liou IW, Ioannou GN. Portal vein thrombosis is not associated with increased mortality among patients with cirrhosis. Clin Gastroenterol Hepatol 2015; 13 (03) 585-593
    CrossrefPubMedGoogle Scholar
  • 20 Law CS, Chatterji M, Chacko K, Schiano TD, Chang CY. Incidence and outcome of newly diagnosed portal vein thrombosis in patients with cirrhosis awaiting liver transplantation. Hepatology 2014; 60: 381A
    PubMedGoogle Scholar
  • 21 Fan X, Huang X, Hershman M. et al. Portal vein thrombosis prevalence and mortality among alcoholic cirrhosis in a nationwide inpatient cohort. Eur J Gastroenterol Hepatol 2020; 32 (09) 1160-1167
    CrossrefPubMedGoogle Scholar
  • 22 Maruyama H, Okugawa H, Takahashi M, Yokosuka O. De novo portal vein thrombosis in virus-related cirrhosis: predictive factors and long-term outcomes. Am J Gastroenterol 2013; 108 (04) 568-574
    CrossrefPubMedGoogle Scholar
  • 23 Attili AF, Lupo M, Gigliotti F, Trapani S, Attili F, De Santis A. Portal vein thrombosis is a risk factor for death and complications in liver cirrhosis. Dig Liver Dis 2012; 44: S107
    CrossrefPubMedGoogle Scholar
  • 24 Girleanu I, Trifan A, Stoica OC. et al. Natural course of portal vein thrombosis in liver cirrhosis. J Gastrointestin Liver Dis 2017; 26: 87-88
    PubMedGoogle Scholar
  • 25 Gokcan H, Kayhan MA, Kacar S. et al. Impact of portal vein thrombosis in the survival of cirrhosis patients. Hepatol Int 2015; 9 (01) S343
    PubMedGoogle Scholar
  • 26 Liaw K, Chang J. Clinical features and 1-year mortality of cirrhotic patients with and without portal vein thrombosis. Hepatol Int 2011; 5 (01) 357
    PubMedGoogle Scholar
  • 27 Wu CY, Yeh HZ, Chen GH. Pharmacologic efficacy in gastric variceal rebleeding and survival: including multivariate analysis. J Clin Gastroenterol 2002; 35 (02) 127-132
    CrossrefPubMedGoogle Scholar
  • 28 Zhang Y, Xu BY, Wang XB. et al. Prevalence and clinical significance of portal vein thrombosis in patients with cirrhosis and acute decompensation. Clin Gastroenterol Hepatol 2020; 18 (11) 2564.e1-2572.e1
    CrossrefPubMedGoogle Scholar
  • 29 John BV, Konjeti R, Aggarwal A. et al. Impact of untreated portal vein thrombosis on pre and post liver transplant outcomes in cirrhosis. Ann Hepatol 2013; 12 (06) 952-958
    CrossrefPubMedGoogle Scholar
  • 30 Chen Z, Ran T, Cao H, Xu F, Zhou ZH, He S. The impact of portal vein thrombosis on the prognosis of patients with cirrhosis: a retrospective propensity-score matched study. Front Med (Lausanne) 2021; 8: 685944
    CrossrefPubMedGoogle Scholar
  • 31 Ferreira CN, Rodrigues T, Sousa P, Ramalho F, Alexandrino P, Velosa JF. Portal vein thrombosis significantly increases mortality in advanced cirrhosis with improved prognosis being associated with portal vein recanalization. Hepatology 2014; 60: 398A-399A
    PubMedGoogle Scholar
  • 32 Girleanu I, Trifan A, Cojocariu C. et al. Natural course of total portal vein thrombosis in patients with cirrhosis. J Hepatol 2014; 60 (01) S247
    CrossrefPubMedGoogle Scholar
  • 33 Noronha Ferreira C, Marinho RT, Cortez-Pinto H. et al. Incidence, predictive factors and clinical significance of development of portal vein thrombosis in cirrhosis: a prospective study. Liver Int 2019; 39 (08) 1459-1467
    CrossrefPubMedGoogle Scholar
  • 34 Violi F, Corazza GR, Caldwell SH. et al; PRO-LIVER Collaborative Group. Incidence and recurrence of portal vein thrombosis in cirrhotic patients. Thromb Haemost 2019; 119 (03) 496-499
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 35 Gao Z, Zhao J, Liu X, Li S, Wang M, Gao Y. Portal vein thrombosis associated with high 14-day and 6-week rebleeding in patients after oesophageal variceal band ligation: a retrospective, multicentre, nested case-control study. Hepatol Int 2021; 15 (05) 1183-1195
    CrossrefPubMedGoogle Scholar
  • 36 Yi F, Guo X, Wang L. et al. Impact of spontaneous splenorenal shunt on liver volume and long-term survival of liver cirrhosis. J Gastroenterol Hepatol 2021; 36 (06) 1694-1702
    CrossrefPubMedGoogle Scholar
  • 37 Yin Y, Li Y, Shao L. et al. Effect of body mass index on the prognosis of liver cirrhosis. Front Nutr 2021; 8: 700132
    CrossrefPubMedGoogle Scholar
  • 38 Peng Y, Qi X, Guo X. Child-Pugh versus MELD score for the assessment of prognosis in liver cirrhosis: a systematic review and meta-analysis of observational studies. Medicine (Baltimore) 2016; 95 (08) e2877
    CrossrefPubMedGoogle Scholar
  • 39 Chinese Society of Hepatology, Chinese Society of Gastroenterology, Chinese Society of Endoscopy. Clinical practice guidelines: prevention and treatment of esophageal and gastric variceal bleeding in cirrhosis and portal hypertension. J Prac Hepatol. 2016; 32 (02) 203-219
    PubMedGoogle Scholar
  • 40 Vilstrup H, Amodio P, Bajaj J. et al. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology 2014; 60 (02) 715-735
    CrossrefPubMedGoogle Scholar
  • 41 Moore KP, Wong F, Gines P. et al. The management of ascites in cirrhosis: report on the consensus conference of the International Ascites Club. Hepatology 2003; 38 (01) 258-266
    CrossrefPubMedGoogle Scholar
  • 42 Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 1999; 94 (446) 496-509
    CrossrefPubMedGoogle Scholar
  • 43 Francoz C, Belghiti J, Vilgrain V. et al. Splanchnic vein thrombosis in candidates for liver transplantation: usefulness of screening and anticoagulation. Gut 2005; 54 (05) 691-697
    CrossrefPubMedGoogle Scholar
  • 44 Cagin YF, Atayan Y, Erdogan MA, Dagtekin F, Colak C. Incidence and clinical presentation of portal vein thrombosis in cirrhotic patients. Hepatobiliary Pancreat Dis Int 2016; 15 (05) 499-503
    CrossrefPubMedGoogle Scholar
  • 45 Margini C, Berzigotti A. Portal vein thrombosis: the role of imaging in the clinical setting. Dig Liver Dis 2017; 49 (02) 113-120
    CrossrefPubMedGoogle Scholar
  • 46 Chen H, Trilok G, Wang F, Qi X, Xiao J, Yang C. A single hospital study on portal vein thrombosis in cirrhotic patients - clinical characteristics & risk factors. Indian J Med Res 2014; 139 (02) 260-266
    PubMedGoogle Scholar
  • 47 Bach AM, Hann LE, Brown KT. et al. Portal vein evaluation with US: comparison to angiography combined with CT arterial portography. Radiology 1996; 201 (01) 149-154
    CrossrefPubMedGoogle Scholar
  • 48 Russell CE, Wadhera RK, Piazza G. Mesenteric venous thrombosis. Circulation 2015; 131 (18) 1599-1603
    CrossrefPubMedGoogle Scholar
  • 49 de Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C. Baveno VII Faculty. Baveno VII - renewing consensus in portal hypertension. J Hepatol 2022; 76 (04) 959-974
    CrossrefPubMedGoogle Scholar
  • 50 Qi X, Guo X, Yoshida EM. et al. Transient portal vein thrombosis in liver cirrhosis. BMC Med 2018; 16 (01) 83
    CrossrefPubMedGoogle Scholar
  • 51 Qi X, Li H, Liu X. et al. Novel insights into the development of portal vein thrombosis in cirrhosis patients. Expert Rev Gastroenterol Hepatol 2015; 9 (11) 1421-1432
    CrossrefPubMedGoogle Scholar
  • 52 Xu S, Guo X, Xu X. et al. Natural history and predictors associated with the evolution of portal venous system thrombosis in liver cirrhosis. Eur J Gastroenterol Hepatol 2021; 33 (1S, Suppl 1): e423-e430
    CrossrefPubMedGoogle Scholar