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Association of nonmalignant portal vein thrombosis and clinical outcomes in patients with cirrhosis and acute variceal bleeding: a multicenter observational study

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Abstract

Background and aim

Baveno VII workshop recommends management of acute variceal bleeding (AVB) in cirrhotic patients with nonmalignant portal vein thrombosis (PVT) should be performed according to the guidelines for patients without PVT. Nevertheless, whether PVT affects the outcome of patients with cirrhosis and AVB remains unclear. The aim of this study was to assess the clinical impact of PVT on the outcomes in the pre-emptive TIPSS eligible patients with cirrhosis and AVB.

Methods

From December 2010 to June 2016, 1219 consecutive cirrhotic patients admitted due to AVB with (n = 151; 12.4%) or without PVT (n = 1068; 87.6%), who received drug plus endoscopic treatment (a combination of vasoactive drugs, antibiotics, and endoscopic ligation for AVB, followed by beta-blockers plus variceal ligation for prevention of rebleeding) were retrospectively included. Fine and Gray competing risk regression models were taken to evaluate the impact of PVT on clinical outcomes after adjusting for potential confounders.

Results

During follow-up, 211 patients (17.3%) died, 490 (40.2%) experienced further bleeding, and 78 (6.4%) experienced new or worsening ascites within 1 year. Compared with those without PVT, patients with PVT had a similar risk of mortality (PVT vs no-PVT: 19.9% vs 16.7% at 1 year; adjusted HR 0.88, 95%CI 0.51–1.52, p = 0.653), further bleeding (47.0% vs 39.2% at 1 year, adjusted HR 1.19, 95% CI 0.92–1.53, p = 183), and new or worsening ascites (7.9% vs 9.6%, adjusted HR 0.70, 95% CI 0.39–1.28, p = 0.253) after adjusting for confounders in multivariable models. These findings were consistent across different relevant subgroups and confirmed by propensity score matching analysis.

Conclusions

Our study showed no evidence that the PVT was associated with an improved or worsened outcome among cirrhotic patients with AVB who received standard treatment.

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Data availability

All data, materials and methods in this study can be made available from the corresponding author upon request for non-commercial purposes and after approval of a study proposal through a signed data access agreement.

Abbreviations

AVB:

Acute variceal bleeding

HBV:

Hepatitis B virus

HCV:

Hepatitis C virus

MELD:

Model for end-stage liver disease

INR:

International normalized ratio

PVT:

Portal vein thrombosis

TIPSS:

Transjugular intrahepatic portosystemic shunt

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Acknowledgements

The authors thank Dr. Luo Zuo from Xijing Hospital of Digestive Disease, Dr. Jiawei Zhong from the First Affiliated Hospital of Nanchang University, Dr. Qifeng Peng from Nanfang Hospital of Southern Medical University, Dr. Fuquan Ma from the First Affiliated Hospital of Xi'an Jiaotong University, Dr. Junyang Luo from the Third Affiliated Hospital of Sun Yat-sen University, Dr. Ming Zhang from Affiliated Drum Tower Hospital of Nanjing University Medical School, Dr. Guangchuan Wang from Shandong Provincial Hospital affiliated to Shandong University, Dr. Minhuang Sun from the Second Affiliated Hospital of Kunming Medical University, and Dr. Junjiao Dong from Henan Provincial People's Hospital for their dedication in data collection; as well as Dr Hui Chen from Xijing Hospital of Digestive Disease for their assistance in revising the manuscript.

Funding

This study was supported by grants from National Key Technology R&D Program (2015BAI13B07) for Prof. Daiming Fan and Boost Program of Xijing Hospital (XJZT18H02) for Prof. Guohong Han and China Postdoctoral Science Foundation (2019TQ0134) for Dr. Yong Lv.

Author information

Authors and Affiliations

  1. Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China

    Yong Lv, Wei Bai, Kai Li, Zhengyu Wang, Bohan Luo, Xiaomei Li, Jie Yuan, Wengang Guo, Dongdong Xia, Zhanxin Yin & Guohong Han

  2. Military Medical Innovation Center, Fourth Military Medical University, Xi’an, China

    Yong Lv & Changbing Yang

  3. Department of Liver Diseases and Interventional Radiology, Digestive Diseases Hospital, Xi’an International Medical Center Hospital, Northwest University, No,777 Xitai Road, High-Tech Zone, Xi’an, 710100, China

    Wei Bai, Zhengyu Wang, Bohan Luo, Xiaomei Li, Jie Yuan, Wengang Guo, Dongdong Xia, Zhanxin Yin & Guohong Han

  4. Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, China

    Xuan Zhu

  5. Department of Gastroenterology, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China

    Hui Xue

  6. Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, China

    Jianbo Zhao

  7. Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China

    Yuzheng Zhuge

  8. Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Hepatobiliary and Pancreatic Intervention Center, Zhejiang University, Hangzhou, China

    Junhui Sun

  9. Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China

    Chunqing Zhang

  10. Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China

    Pengxu Ding

  11. Department of Interventional Radiology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China

    Zaibo Jiang

  12. Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China

    Xiaoli Zhu

  13. Department of Interventional Radiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China

    Weixin Ren

  14. Department of Interventional Radiology, Second Affiliated Hospital of Kunming Medical University, Kunming, China

    Yingchun Kewei LiZhang

  15. Department of Vascular Surgery, Henan Provincial People’s Hospital, Zhengzhou, China

    Yingchun Kewei LiZhang

  16. Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China

    Wenguang Zhang

  17. State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China

    Zhiping Yang, Huahong Xie, Yanglin Pan & Daiming Fan

Authors
  1. Yong Lv
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  2. Wei Bai
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  3. Xuan Zhu
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  4. Hui Xue
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  5. Jianbo Zhao
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  6. Yuzheng Zhuge
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  7. Junhui Sun
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  8. Chunqing Zhang
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  9. Pengxu Ding
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  10. Zaibo Jiang
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  11. Xiaoli Zhu
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  12. Weixin Ren
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  13. Yingchun Kewei LiZhang
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  21. Wengang Guo
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  27. Daiming Fan
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  28. Guohong Han
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Contributions

Study concept and design: YL, GH; Acquisition of data: YL, WB, XZ, HX, JZ, YZ, JS, CZ, PD, ZJ, XZ, WR, YL, KZ, WZ, KL, ZW, BL, XL, ZY, QW, WG, DDX, ZY, GH; Analysis and interpretation of data: YL, GH; Drafting of the manuscript: YL; Critical revision of the manuscript for important intellectual content: CY, YP, DF, GH; Statistical analysis: YL; Administrative and material support: DF.

Corresponding author

Correspondence to Guohong Han.

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Conflict of interest

Yong Lv, Wei Bai, Xuan Zhu, Hui Xue, Jianbo Zhao, Yuzheng Zhuge, Junhui Sun, Chunqing Zhang, Pengxu Ding, Zaibo Jiang, Xiaoli Zhu, Weixin Ren, Yingchun Li, Kewei Zhang, Wenguang Zhang, Kai Li, Zhengyu Wang, Bohan Luo, Xiaomei Li, Jie Yuan, Zhiping Yang, Wengang Guo, Dongdong Xia, Huahong Xie, Changbing Yang, Yanglin Pan, Zhanxin Yin, Daiming Fan, Guohong Han have nothing to declare.

Ethical approval

Permission for retrospective data analyses was obtained from the Ethics Committees of all participating centers. The study was performed according to the ethical guidelines of the Declaration of Helsinki (seventh revision).

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All included patients have given their informed consent to the initial studies.

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Lv, Y., Bai, W., Zhu, X. et al. Association of nonmalignant portal vein thrombosis and clinical outcomes in patients with cirrhosis and acute variceal bleeding: a multicenter observational study. Hepatol Int 17, 1192–1204 (2023). https://doi.org/10.1007/s12072-023-10493-1

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