Nottingham Digestive Diseases Centre (NDDC), Translational Medical Sciences, School of Medicine, University of Nottingham, NG7 2UH, UK; NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, NG7 2UH, UK.
Royal Gwent Unit, Royal Gwent Hospital, Newport, NP20 2UB, UK.
Thromb Res. 2022 Jul;215:19-29. doi: 10.1016/j.thromres.2022.05.004. Epub 2022 May 17.
Historically, bleeding was thought to be a frequent and fatal complication of liver disease. However, thrombosis due to coagulation disorders in cirrhosis remains a real risk. We aim to systematically analyse published articles to evaluate epidemiology of venous thromboembolism (VTE) in chronic liver disease (CLD).
Electronic search was conducted on Ovid Medline, EMBASE and Scopus from inception to November 2021 to identify studies presenting epidemiology VTE (deep vein thrombosis and pulmonary embolism) in CLD in inpatients and/or community settings. Random-effects meta-analysis was performed to determine pooled per-year cumulative incidence, incidence rate and prevalence. Heterogeneity was measured by I test, and, potential sources of heterogeneity by meta-regression and sensitivity analysis. PROSPERO registration-CRD42021239117.
Twenty-nine studies comprising 19,157,018 participants were included, of which 15,2049 (0.79%) had VTE. None of the included studies were done in the community. In hospitalised patients with CLD: pooled cumulative incidence of VTE was 1.07% (95% CI 0.80,1.38) per-year, incidence rate was 157.15 (95% CI 14.74,445.29) per 10,000 person-years, and period prevalence was 1.10% (95% CI 0.85,1.38) per year. There was significant heterogeneity and publication bias. Pooled relative risk (RR) of studies reporting incidence rate was 2.11 (95% CI 1.35,3.31). CLD patients (n = 1644), who did not receive pharmacological prophylaxis were at 2.78 times (95% CI 1.11, 6.98) increased risk of VTE compared to those receiving prophylaxis.
Hospitalised patients with CLD may be at an increased risk of VTE. For every 1000 hospitalised patients with CLD ten have new, and eleven have pre-existing diagnoses of VTE per-year.
历史上，出血被认为是肝脏疾病的常见且致命的并发症。然而，肝硬化引起的凝血障碍导致的血栓形成仍然是一个真正的风险。我们旨在系统地分析已发表的文章，以评估慢性肝病（CLD）中静脉血栓栓塞症（VTE）的流行病学。
我们在 Ovid Medline、EMBASE 和 Scopus 上进行了电子检索，检索时间从建库至 2021 年 11 月，以确定在住院和/或社区环境中报告 CLD 患者 VTE（深静脉血栓形成和肺栓塞）流行病学的研究。采用随机效应荟萃分析确定累积发生率、发病率和患病率的汇总值。采用 I 检验测量异质性，并采用亚组分析和敏感性分析测量潜在的异质性来源。PROSPERO 注册号-CRD42021239117。
共纳入 29 项研究，包含 19157018 名参与者，其中 152049 名（0.79%）患有 VTE。纳入的研究均未在社区中进行。在患有 CLD 的住院患者中：VTE 的累积发生率为每年 1.07%（95%CI 0.80%，1.38%），发病率为每 10000 人年 157.15（95%CI 14.74，445.29），期间患病率为每年 1.10%（95%CI 0.85%，1.38%）。存在显著的异质性和发表偏倚。报告发病率的研究的汇总相对风险（RR）为 2.11（95%CI 1.35，3.31）。与接受药物预防的患者相比，未接受药物预防的 CLD 患者（n=1644）发生 VTE 的风险增加了 2.78 倍（95%CI 1.11，6.98）。
CLD 住院患者可能面临更高的 VTE 风险。每 1000 名患有 CLD 的住院患者中，每年有 10 名新诊断为 VTE，11 名患者为既往诊断为 VTE。
