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Publications

Journal Article Ahead of print

PubMed: 42766768 DOI: 10.1097/LVT.0000000000000994

Portal vein thrombosis increases short-term mortality among hospitalized patients with cirrhosis in a global cohort.

Liver Transpl

Authors: Ashok Choudhury, Scott Silvey, Florence Wong, Patrick S Kamath, Jacob George, Ramazan Idilman, Mark Topazian, Aldo Torre, Mário Reis Álvares-da-Silva, Qing Xie, Peter Hayes, Wai Kay Seto, Shiv K Sarin, Jacqueline Cordova-Gallardo, Suresh Vasan Venkatachalapathy, Xiangmei Wang, Patricia Zitelli, Hak-Keith Leung, Hibat Allah Belimi, Bin Xu, Francisco Félix-Tellez, Robert Livingstone, Mingqin Lu, Feng Peng, Busra Haktaniyan, Liou Wei Lun, Shalimar, Ashish Goel, K Rajender Reddy, Katina Zheng, Surender Kumar, Mohammad Rela, Ajay Jhaveri, Richard Goodheart, Dinç Dinçer, Kessarin Thanapirom, Henok Fisseha, Yue Wang, Sarai Gonzalez Hueso, Lilian Torres Made, Paula Guedes, Neil Rajoriya, Tao Li, Cameron Gofton, Harendran Elangovan, Gerry MacQuillan, Luis Garrido Trevino, Wei Wang, Stephen Riordan, Dibyalochan Praharaj … and 44 other authors

Affiliations

  • Institute of Liver and Biliary Sciences, New Delhi, India.
  • School of Public Health, Virginia Commonwealth University, Richmond, USA.
  • University of Toronto, Canada.
  • Mayo Clinic School of Medicine, Rochester, USA.
  • Westmead Institute for Medical Research, University of Sydney, Australia.
  • Ankara University, Turkey.
  • St. Paul's Hospital Millennium Medical College, Ethiopia.
  • Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico.
  • Federal University of Rio Grande do Sul, Brazil.
  • Shanghai Jiao Tong University School of Medicine, China.
  • University of Edinburgh, United Kingdom.
  • University of Hong Kong, Hong Kong.
  • Hospital General "Dr. Manuel Gea González", Mexico.
  • Nottingham University Hospitals NHS Trust, UK.
  • Mengchao Hepatobiliary Hospital, China.
  • University of São Paulo, Brazil.
  • University of Malaya Medical Centre, Malaysia.
  • Mustapha Bacha University Hospital, Algeria.
  • Beijing Youan Hospital, China.
  • Hospital Civil de Guadalajara, Mexico.
  • Royal Berkshire Hospital, UK.
  • Wenzhou Medical University, China.
  • Central South University, China.
  • Ankara University School of Medicine, Turkey.
  • Singapore General Hospital, Singapore.
  • All India Institute of Medical Sciences, New Delhi, India.
  • Christian Medical College, Vellore, India.
  • University of Pennsylvania, USA.
  • SGPGIMS, Lucknow, India.
  • Dr. Rela Institute, Chennai, India.
  • Jaslok Hospital, Mumbai, India.
  • Royal Perth Hospital, Australia.
  • Akdeniz University, Turkey.
  • Chulalongkorn University, Thailand.
  • Fifth People's Hospital of Suzhou, China.
  • Centro Médico ISSEMYM, Mexico.
  • Instituto de Salud Digestiva y Hepática, Mexico.
  • Hospital Federal de Bonsucesso, Brazil.
  • Queen Elizabeth Hospital, UK.
  • Shandong University, China.
  • Royal North Shore Hospital, Australia.
  • Sir Charles Gairdner Hospital, Australia.
  • Baylor University Medical Center, USA.
  • Hebei Medical University, China.
  • Prince of Wales Hospital, Australia.
  • KIMS, Bhubaneswar, India.

Abstract

BACKGROUND

Portal vein thrombosis (PVT) in cirrhosis is associated with adverse outcomes, but determinants of PVT and its impact on short-term outcomes in hospitalized patients across global regions remain unclear.

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.

MeSH

Liver Transplantation, Mortality, Non-Alcoholic Fatty Liver Disease, Portal Vein, Thrombosis, Veins, Hepatitis