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Portal vein thrombosis associated with high 14-day and 6-week rebleeding in patients after oesophageal variceal band ligation: a retrospective, multicentre, nested case–control study

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Abstract

Background and aims

The association between prognosis of variceal bleeding and portal vein thrombosis (PVT) is unclear. In this multicentre study, we determined the effect of PVT on rebleeding and mortality in patients with acute variceal bleeding (AVB) after oesophageal variceal band ligation (EVL).

Methods

Cirrhotic patients with AVB who had undergone EVL were included. The patients were allocated to either the PVT group or the control cirrhotic group (CCG) based on the presence or absence of PVT. One-year rebleeding episodes and mortality after EVL were recorded.

Results

A total of 218 cirrhotic patients with AVB from 3 centres were included. Patients with PVT had a higher rate of 14-day and 6-week rebleeding than those without PVT (14-day: 8.26% vs. 1.83%, p = 0.03; 6-week: 11.92% vs. 1.83%, p = 0.003). The rates of 5-day failure (3.67% vs. 0.92%, p = 0.175), 1-year rebleeding (21.10% vs. 20.18%, p = 0.867), and 14-day, 6-week, and 1-year mortality were similar between the groups (14-day: 3.67% vs. 0.92%, p = 0.175; 6-week: 3.67% vs. 0.92%, p = 0.175; 1-year: 3.67% vs. 1.83%, p = 0.408). The Child–Pugh class [p = 0.022, hazard ratio (HR): 1.453; 95% confidence interval (CI) 1.056–1.998], PVT (p = 0.050, HR: 4.622, 95% CI 0.999–21.395), albumin < 30 g/L (p = 0.023, HR: 5.886, 95% CI 1.272–27.245), and number of bands (p = 0.010, HR: 1.207, 95% CI 1.046–1.393) were identified as the predictors for 14-day rebleeding; the multivariate analysis revealed only the number of bands (p = 0.009, HR: 1.247, 95% CI 1.056–1.473) as the independent factor. PVT (p = 0.012, HR: 6.732, 95% CI 1.519–29.835) and albumin < 30 g/L (p = 0.027, HR: 3.643, 95% CI 1.160–11.441) were identified as predictors for 6-week rebleeding; however, only PVT (p = 0.015, HR: 6.380, 95% CI 1.427–28.515) was found to be the independent factor in the multivariate analysis. Further analysis showed that superior mesenteric vein (SMV) thrombosis is the only risk factor predicting 6-week rebleeding in patients with PVT (p = 0.032, HR: 3.405, 95% CI 1.112–10.429).

Conclusions

PVT was associated with high 14-day and 6-week rebleeding in patients after EVL. SMV thrombosis was the only risk factor for 6-week rebleeding in patients with PVT. High albumin levels may serve as a protective factor for the 14-day and 6-week rebleeding risk. PVT was not responsible for mortality after EVL during 1-year follow-up.

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All date generated or analyzed during this study are included in this published article.

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Acknowledgements

We are sincerely grateful to the physicians and all co-medical staff.

Funding

There is no financial support of this study.

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Authors and Affiliations

  1. Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, People’s Republic of China

    Zhanjuan Gao & Yanjing Gao

  2. Department of Gastroenterology, Liaocheng People’s Hospital, Liaocheng, Shandong Province, People’s Republic of China

    Zhanjuan Gao, Jingrun Zhao & Senlin Li

  3. Department of Gastroenterology, Chinese People’s Liberation Army No.960 Hospital, Jinan, Shandong Province, People’s Republic of China

    Xiaofeng Liu & Minghui Wang

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  1. Zhanjuan Gao
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  4. Senlin Li
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  5. Minghui Wang
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  6. Yanjing Gao
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Contributions

Professor YG designed and administrated the study. ZG conducted the study, collected and interpreted the data, drafted the manuscript. J-RZ interpreted the result and supervised the study. XL and SL administrated the study. MW collected the date. All authors had access to the study data and had reviewed and approved the final manuscript.

Corresponding author

Correspondence to Yanjing Gao.

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Conflict of interest

Zhanjuan Gao, Jingrun Zhao, Xiaofeng Liu, Senlin Li, Minghui Wang,Yanjing Gao declare that there is no conflict of interest.

Ethical approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975. Each institution approved the protocol, and the data of all patients were recorded in a standard form. Because of retrospective, we did not have consent to participate, but all the patients information will be kept strictly confidential.

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This article does not contain any studies with animal subjects.

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Informed consent for publication was obtained from all participants (Zhanjuan Gao, Jingrun Zhao, Xiaofeng Liu, Senlin Li, Minghui Wang, Yanjing Gao).

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Gao, Z., Zhao, J., Liu, X. et al. Portal vein thrombosis associated with high 14-day and 6-week rebleeding in patients after oesophageal variceal band ligation: a retrospective, multicentre, nested case–control study. Hepatol Int 15, 1183–1195 (2021). https://doi.org/10.1007/s12072-021-10224-4

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  • DOI: https://doi.org/10.1007/s12072-021-10224-4

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