Garg Rajat, Mohammed Abdul, Singh Amandeep, Siddiki Hassan, Bhatt Amit, Sanaka Madhusudhan R, Jang Sunguk, Simons-Linares C Roberto, Stevens Tyler, Vargo John, Chahal Prabhleen
Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
Department of Gastroenterology and Hepatology, Advent Health, Orlando, FL, USA.
Dig Dis Sci. 2023 Jun;68(6):2674-2682. doi: 10.1007/s10620-023-07945-x. Epub 2023 Apr 25.
Portal vein thrombosis (PVT) is a rare complication of acute pancreatitis (AP) and might be associated with worse outcomes. We aimed to study trends, outcomes, and predictors of PVT in AP patients.
The National Inpatient Sample database was utilized to identify the adult patients (≥ 18 years) with primary diagnosis of AP from 2004 to 2013 using International Classification of Disease, Ninth Revision. Patients with and without PVT were entered into propensity matching model based on baseline variables. Outcomes were compared between both groups and predictors of PVT in AP were identified.
Among the total of 2,389,337 AP cases, 7046 (0.3%) had associated PVT. The overall mortality of AP decreased throughout the study period (p trend ≤ 0.0001), whereas mortality of AP with PVT remained stable (1-5.7%, p trend = 0.3). After propensity matching, AP patients with PVT patients had significantly higher in-hospital mortality (3.3% vs. 1.2%), AKI (13.4% vs. 7.7%), shock (6.9% vs. 2.5%), and need for mechanical ventilation (9.2% vs. 2.5%) along with mean higher cost of hospitalization and length of stay (p < 0.001 for all). Lower age (Odd ratio [OR] 0.99), female (OR 0.75), and gallstone pancreatitis (OR 0.79) were negative predictors, whereas alcoholic pancreatitis (OR 1.51), cirrhosis (OR 2.19), CCI > 2 (OR 1.81), and chronic pancreatitis (OR 2.28) were positive predictors of PVT (p < 0.001 for all) in AP patients.
PVT in AP is associated with significantly higher risk of death, AKI, shock, and need for mechanical ventilation. Chronic and alcoholic pancreatitis is associated with higher risk of PVT in AP.
门静脉血栓形成（PVT）是急性胰腺炎（AP）的一种罕见并发症，可能与更差的预后相关。我们旨在研究AP患者中PVT的趋势、预后及预测因素。
利用国家住院样本数据库，通过国际疾病分类第九版识别2004年至2013年期间初次诊断为AP的成年患者（≥18岁）。根据基线变量，将有和无PVT的患者纳入倾向匹配模型。比较两组的预后，并确定AP中PVT的预测因素。
在总计2389337例AP病例中，7046例（0.3%）合并PVT。在整个研究期间，AP的总体死亡率下降（p趋势≤0.0001），而合并PVT的AP患者死亡率保持稳定（1%-5.7%，p趋势=0.3）。倾向匹配后，合并PVT的AP患者住院死亡率显著更高（3.3%对1.2%）、急性肾损伤（13.4%对7.7%）、休克（6.9%对2.5%）以及需要机械通气（9.2%对2.5%），同时住院平均费用和住院时间更高（所有p<0.001）。年龄较低（比值比[OR]0.99）、女性（OR 0.75）和胆石性胰腺炎（OR 0.79）为阴性预测因素，而酒精性胰腺炎（OR 1.51）、肝硬化（OR 2.19）、Charlson合并症指数>2（OR 1.81）和慢性胰腺炎（OR 2.28）是AP患者中PVT的阳性预测因素（所有p<0.001）。
AP中的PVT与死亡、急性肾损伤、休克及需要机械通气的风险显著更高相关。慢性和酒精性胰腺炎与AP中PVT的较高风险相关。
