Predictive factors for portal vein thrombosis after splenectomy in cirrhotic patients with portal hypertension

Objective To investigate the cause of portal vein thrombosis ( PVT) after esophagogastric devascularization and splenectomy in cirrhotic patients with portal hypertension ( PH) . Methods A retrospective analysis was performed for the clinical data of 123 patients who were admitted to The Affiliated Hospital of Qingdao University from January, 2012 to August, 2016 and underwent esophagogastric devascularization and splenectomy, and according to the presence or absence of PVT after surgery, these patients were divided into PVT group and non-PVT group. The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. The logistic regression model was used for multivariate analysis, and the area under the curve ( AUC) was used to compare the predictive value of influencing factors. Results Of all patients, 37 experienced PVT after esophagogastric devascularization and splenectomy, resulting in an incidence rate of 30. 08% . The univariate analysis of the PVT group and the non-PVT group showed that there were significant differences between the two groups in preoperative body mass index ( BMI) ( t = 2. 291, P < 0. 05) , Model for End-Stage Liver Disease ( MELD) score ( t = 1. 852, P < 0. 05) , portal vein diameter ( t = 1. 982, P < 0. 05) , splenic vein diameter ( t = 2. 582, P < 0. 05) , superior mesenteric vein diameter ( t = 2. 186, P < 0. 05) , flow rate of the splenic vein ( t = 2. 109, P < 0. 05) , and method for the resection of the splenic pedicle ( χ2= 4. 505, P < 0. 05) . As for Child-Pugh class A patients, there were significant differences between the PVT group and the non-PVT group in splenic vein diameter, superior mesenteric vein diameter, portal vein diameter, and preoperative BMI ( t = 2. 347, 2. 654, 2. 312, and 2. 187, all P < 0. 05) . The multivariate logistic regression analysis showed that BMI ( odds ratio [OR]= 0. 859, 95% confidence interval [CI]: 0. 750-0. 983, P = 0. 027) , splenic vein diameter ( OR = 1. 191, 95% CI:1. 035-1. 370, P = 0. 015) , flow rate of the splenic vein ( OR = 1. 125, 95% CI: 1. 004-1. 262, P = 0. 043) , superior mesenteric vein diameter ( OR = 1. 202, 95% CI: 1. 001-1. 444, P = 0. 048) , and primary splenic pedicle resection ( OR = 2. 815, 95% CI: 1. 056-7. 503, P = 0. 039) were independent risk factors for PVT after surgery. Preoperative BMI < 22. 54 kg/m2 ( sensitivity 75. 9% and specificity 58. 3% ) or preoperative splenic vein diameter > 11. 5 mm ( sensitivity 72. 7% and specificity 62. 9% ) suggested a higher risk of PVT after esophagogastric devascularization and splenectomy. Conclusion Preoperative splenic vein diameter and BMI are associated with PVT after surgery, and monitoring of these two indices helps to predict PVT in the early stage.