Department of Medicine, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York, USA.
Division of Gastroenterology and Hepatology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York, USA.
J Gastroenterol Hepatol. 2019 Jun;34(6):1088-1092. doi: 10.1111/jgh.14501. Epub 2018 Nov 4.
Portal vein thrombosis (PVT) is increasingly common in cirrhotics, but its impact on mortality and outcomes is unclear. Studies evaluating PVT have been limited by small sample size. This study analyzes the trend of the prevalence of PVT and its associated mortality in hospitalized decompensated cirrhotics.
The Nationwide Inpatient Sample, the largest nationally representative database of hospital discharges, was queried from 1998 to 2014. Inpatients older than 18 years with decompensated cirrhosis were included, while those who received liver transplantation or had hepatocellular carcinoma were excluded. The primary outcomes were the trend in prevalence and associated mortality with PVT. Secondary outcomes included identifying risk factors of PVT and the effect of PVT on complications of portal hypertension. Multivariable logistic regression evaluated the outcomes.
A total of 3 045 098 discharges were included, of which 1.5% had PVT. PVT prevalence increased from 0.7% to 2.4%, annual percent change of 9%. Mortality associated with PVT declined from 11.9% to 9.1%, annual percent change of -3.0%. In multivariable analysis controlling for factors associated with mortality in cirrhotics, PVT was associated with an increased risk of mortality (OR 1.12, P < 0.001). Multivariable logistic regression also demonstrated that PVT significantly increased the risk of acute kidney injury (OR 1.75, P < 0.001) and hepatorenal syndrome (OR 1.62, P < 0.001).
The prevalence of PVT is increasing while its associated mortality is decreasing. However, PVT still is associated with risk of mortality and kidney injury, implying a significant impact on cirrhotic outcomes.
门静脉血栓形成（PVT）在肝硬化患者中越来越常见，但它对死亡率和预后的影响尚不清楚。评估 PVT 的研究受到样本量小的限制。本研究分析了住院失代偿期肝硬化患者中 PVT 的流行趋势及其相关死亡率。
从 1998 年至 2014 年，我们查询了全国住院患者样本（NIS），这是最大的全国代表性住院患者数据库。纳入年龄大于 18 岁的失代偿性肝硬化患者，排除接受肝移植或患有肝细胞癌的患者。主要结局是 PVT 的流行趋势及其相关死亡率。次要结局包括确定 PVT 的危险因素以及 PVT 对门脉高压并发症的影响。多变量逻辑回归评估结局。
共纳入 3045098 例出院患者，其中 1.5%有 PVT。PVT 的患病率从 0.7%增加到 2.4%，年变化率为 9%。与 PVT 相关的死亡率从 11.9%下降到 9.1%，年变化率为-3.0%。在多变量分析中，控制与肝硬化患者死亡率相关的因素后，PVT 与死亡率增加相关（OR 1.12，P<0.001）。多变量逻辑回归还表明，PVT 显著增加了急性肾损伤（OR 1.75，P<0.001）和肝肾综合征（OR 1.62，P<0.001）的风险。
PVT 的患病率在增加，而相关死亡率在下降。然而，PVT 仍然与死亡率和肾损伤的风险相关，这意味着它对肝硬化患者的预后有重大影响。
