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Mortality Trends, Outcomes, and Predictors of Portal Vein Thrombosis in Acute Pancreatitis Patients: A Propensity-Matched National Study

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

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Author notes

  1. Rajat Garg and Abdul Mohammed are co-first authors.

Authors and Affiliations

  1. Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA

    Rajat Garg, Amandeep Singh, Hassan Siddiki, Amit Bhatt, Madhusudhan R. Sanaka, Sunguk Jang, C. Roberto Simons-Linares, Tyler Stevens, John Vargo & Prabhleen Chahal

  2. Department of Gastroenterology and Hepatology, Advent Health, Orlando, FL, USA

    Abdul Mohammed

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Contributions

RG, AS, and PC contributed to conception and design and drafting of the article, RG and AM contributed to initial draft, RG contributed to data collection and synthesis, statistical analysis of data, and interpretation of results. All authors contributed to critical revision of the article for important intellectual content and final approval of the article.

Corresponding author

Correspondence to Rajat Garg.

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Conflict of interest

All authors declare they have nothing to disclose.

Ethical approval

Due to the de-identified nature of the NIS, no Institutional Review Board approval was required for this study.

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An abstract of this manuscript was presented as oral presentation at the American College of Gastroenterology, 2021, Las Vegas, NV.

Electronic supplementary material

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10620_2023_7945_MOESM1_ESM.tiff

Supplementary file1 (TIFF 1143 KB) Supplementary Figure 1: Love plot showing covariate balance before and after propensity matching

Appendix

Appendix

ICD-9 codes.

Acute pancreatitis

577.0

Portal vein thrombosis

452

Antiplatelet/antithrombotic

V58.63, V58.66

Anticoagulant use

V58.61

Chronic pancreatitis

577.1

Gall stones

574, 574.00, 574.01, 574.10, 574.11, 574.20, 574.21, 574.30, 574.31, 574.40, 574.41, 574.50, 574.51, 574.60, 574.61, 574.70, 574.71, 574.80, 574.81, 574.90, 574.91

Alcohol related

291.0, 291.1, 291.2, 291.3, 291.4, 291.5,291.81, 291.82, 291.89, 291.9, 303.00, 303.01, 303.02, 303.03, 303.90, 303.91,303.92, 303.93, 305.00, 305.01, 305.02, 305.03, 980.0, 357.5, 425.5, 535.30, 535.31, 571.0, 571.1, 571.2, 571.3

Liver cirrhosis

571.2, 571.5, 571.6

Mechanical ventilation

96.04, 96.05, 96.7, 96.70, 96.71, 96.72

Shock

7850, 78550, 78551, 78552, 78559

Smoking

305.1, V15.82

AKI

845, 5846, 5847, 5848, 5849, 586

Cyst and pseudocyst of pancreas

577.2

Percutaneous drainage

PR52.01

Surgical pancreatectomy

PR52.5, 52.51, 52.53, 52.59, 52.6, 52.7

Liver transplant

V42.7

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Garg, R., Mohammed, A., Singh, A. et al. Mortality Trends, Outcomes, and Predictors of Portal Vein Thrombosis in Acute Pancreatitis Patients: A Propensity-Matched National Study. Dig Dis Sci 68, 2674–2682 (2023). https://doi.org/10.1007/s10620-023-07945-x

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