Cangemi Roberto, Raparelli Valeria, Talerico Giovanni, Basili Stefania, Violi Francesco
Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
Faculties of Nursing, Medicine and School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
Gastro Hep Adv. 2024 Mar 13;3(5):646-653. doi: 10.1016/j.gastha.2024.03.006. eCollection 2024.
Hypoalbuminemia, as defined by serum albumin (SA) levels ≤35 g/L, is associated to venous and arterial thrombosis in general population and in patients at risk of cardiovascular disease. It is unknown if SA ≤35 g/L is also associated to portal vein thrombosis (PVT) in cirrhosis.
Cirrhotic patients enrolled in the Portal vein thrombosis Relevance On Liver cirrhosis: Italian Venous thrombotic Events Registry (PRO-LIVER) study (n = 753), were followed-up for 2 years to assess the risk of PVT, that was diagnosed by Doppler ultrasonography. Child-Pugh classes, Model for End-Stage Liver Disease score, presence of hepatocellular carcinoma and laboratory variables including SA, D-dimer, and high-sensitivity C-reactive protein (hs-CRP) were measured at baseline.
SA ≤35 g/L was detected in 52% of patients. A logistic multivariate regression analysis showed that higher Child-Pugh class, hepatocellular carcinoma and thrombocytopenia were significantly associated to SA ≤35 g/L. In a subgroup of patients where data regarding hs-CRP and D-dimer were available, SA ≤35 g/L was inversely associated with hs-CRP and D-dimer. During the follow-up, a total of 61 patients experienced PVT. A Kaplan Meier survival analysis showed SA ≤35 g/L was associated to increased risk of PVT compared to SA >35 g/L ( = .005). A multivariate Cox proportional hazards regression analysis showed that male sex, lower platelet count, and SA ≤35 g/L remained associated to PVT after adjusting for confounding factors.
Cirrhotic patients with SA ≤35 g/L are at higher risk of experiencing PVT compared to those with SA >35 g/L and could be considered as potential candidates to anticoagulant prophylaxis for PVT prevention.
血清白蛋白（SA）水平≤35 g/L所定义的低白蛋白血症，在普通人群以及有心血管疾病风险的患者中与静脉和动脉血栓形成相关。目前尚不清楚SA≤35 g/L是否也与肝硬化患者的门静脉血栓形成（PVT）有关。
纳入门静脉血栓形成与肝硬化相关性：意大利静脉血栓事件登记研究（PRO-LIVER）的肝硬化患者（n = 753），随访2年以评估PVT风险，PVT通过多普勒超声诊断。在基线时测量Child-Pugh分级、终末期肝病模型评分、肝细胞癌的存在情况以及包括SA、D-二聚体和高敏C反应蛋白（hs-CRP）在内的实验室变量。
52%的患者检测到SA≤35 g/L。多因素logistic回归分析显示，较高的Child-Pugh分级、肝细胞癌和血小板减少与SA≤35 g/L显著相关。在可获得hs-CRP和D-二聚体数据的患者亚组中，SA≤35 g/L与hs-CRP和D-二聚体呈负相关。在随访期间，共有61例患者发生PVT。Kaplan-Meier生存分析显示，与SA>35 g/L相比，SA≤35 g/L与PVT风险增加相关（P = .005）。多因素Cox比例风险回归分析显示，在调整混杂因素后，男性、较低的血小板计数和SA≤35 g/L仍与PVT相关。
与SA>35 g/L的肝硬化患者相比，SA≤35 g/L的肝硬化患者发生PVT的风险更高，可被视为预防PVT进行抗凝预防的潜在候选者。
