Risk factors of portal vein thrombosis in cirrhotic patients with esophageal varices

Huaiwen ZUO; Qimei SHA; Jiao SUN; Zhihui CAI; Hongwei XU; Hui LIU

doi:10.3969/j.issn.1001-5256.2021.01.013

Volume 37 Issue 1

Jan. 2021

Turn off MathJax

Article Contents

Abstract

References

Article Navigation > Journal of Clinical Hepatology > 2021 > 37(1): 63-67

PDF( 2249 KB)

Risk factors of portal vein thrombosis in cirrhotic patients with esophageal varices

DOI: 10.3969/j.issn.1001-5256.2021.01.013

1.
Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
2.
Department of Special Clinical Laboratory, Shandong Police Hospital, Jinan 250002, China
3.
Department of Gastroenterology, Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China

Received Date: 2020-08-02
Accepted Date: 2020-08-31
Published Date: 2021-01-20

Abstract

Abstract

Objective To investigate the risk factors for portal vein thrombosis (PVT) in cirrhotic patients with esophageal varices, and to establish a nomogram for predicting the risk of PVT. Methods A retrospective analysis was performed for the clinical data of 283 cirrhotic patients with esophageal varices who attended Shandong Provincial Hospital Affiliated to Shandong University from December 2013 to December 2018, and according to imaging findings, the patients were divided into PVT group with 119 patients and non-PVT group with 164 patients. The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. A multivariate logistic regression analysis was used to screen out independent risk factors; a nomogram was established and validated based on the results of the multivariate logistic regression analysis, and C-index and calibration curve were used to evaluate its performance. Results The univariate analysis showed that compared with the non-PVT group, the PVT group had significantly higher Child-Pugh class (χ²=9.388, P=0.009), proportion of patients with a history of splenectomy (χ²=26.805, P < 0.001), white blood cell count (Z=-2.248, P=0.025), platelet count (Z=-3.323, P=0.001), D-dimer(Z=-6.236, P < 0.001), and spleen thickness (Z=-2.432, P=0.015) and a significantly lower level of triglyceride (TG) (Z=-4.150, P < 0.001). The multivariate logistic regression analysis showed that a reduction in TG (odds ratio [OR]=0.441, 95% confidence interval [CI]: 0.190-0.889), an increase in D-dimer (OR=1.151, 95%CI: 1.041-1.272), prolonged prothrombin time (PT) (OR=1.160, 95%CI: 1.025-1.313), and a history of splenectomy (OR=2.933, 95%CI: 1.164-7.389) were independent risk factors for PVT in cirrhotic patients with esophageal varices. In addition, a nomogram was established based on the results of the multivariate regression analysis, with a C-index of 0.745, and the calibration curve showed good consistency between the observed and predicted values for the development of PVT. Conclusion A reduction in TG, an increase in D-dimer, prolonged PT, and a history of splenectomy are independent risk factors for PVT in cirrhotic patients with esophageal varices, and the nomogram developed based on these results can provide a quantitative and intuitive tool for clinicians to assess the risk of PVT.
- Liver Cirrhosis,
- Portal Vein Thrombosis,
- Esophageal and Gastric Varices,
- Risk Factors,
- Nomogram

FullText(HTML)

References(24)

References

[1]	ZOCCO MA, DI STASIO E, de CRISTOFARO R, et al. Thrombotic risk factors in patients with liver cirrhosis: Correlation with MELD scoring system and portal vein thrombosis development[J]. J Hepatol, 2009, 51(4): 682-689. DOI: 10.1016/j.jhep.2009.03.013
[2]	RUAN FM, LI BM. Risk factors for the formation of portal vein thrombosis in patients with liver cirrhosis[J]. J Clin Hepatol, 2020, 36(1): 182-185. (in Chinese) DOI: 10.3969/j.issn.1001-5256.2020.01.043 阮芳鸣, 李弼民. 肝硬化门静脉血栓形成的危险因素[J]. 临床肝胆病杂志, 2020, 36(1) : 182-185. DOI: 10.3969/j.issn.1001-5256.2020.01.043
[3]	NORONHA FERREIRA C, MARINHO RT, CORTEZ-PINTO H, et al. Incidence, predictive factors and clinical significance of development of portal vein thrombosis in cirrhosis: A prospective study[J]. Liver Int, 2019, 39(8): 1459-1467. DOI: 10.1111/liv.14121
[4]	GUO YL, XU BH, LIU X, et al. Risk factors analysis of early rebleeding after endoscopic treatment of esophageal varices[J]. Chin J Dig Endosc, 2018, 35(2): 89-93. (in Chinese) DOI: 10.3760/cma.j.issn.1007-5232.2018.02.003 郭雅丽, 徐宝宏, 刘贤, 等. 食管静脉曲张内镜治疗术后早期再出血的危险因素分析[J]. 中华消化内镜杂志, 2018, 35(2): 89-93. DOI: 10.3760/cma.j.issn.1007-5232.2018.02.003
[5]	QI X, SU C, REN W, et al. Association between portal vein thrombosis and risk of bleeding in liver cirrhosis: A systematic review of the literature[J]. Clin Res Hepatol Gastroenterol, 2015, 39(6): 683-691. DOI: 10.1016/j.clinre.2015.02.012
[6]	TARZAMNI MK, SOMI MH, FARHANG S, et al. Portal hemodynamics as predictors of high risk esophageal varices in cirrhotic patients[J]. World J Gastroenterol, 2008, 14(12): 1898-1902. DOI: 10.3748/wjg.14.1898
[7]	STINE JG, WANG J, SHAH PM, et al. Decreased portal vein velocity is predictive of the development of portal vein thrombosis: A matched case-control study[J]. Liver Int, 2018, 38(1): 94-101. DOI: 10.1111/liv.13500
[8]	Chinese Society of Hepatology, Chinese Medical Association. Chinese guidelines on the management of liver cirrhosis[J]. J Clin Hepatol, 2019, 35(11): 2408-2425. (in Chinese) DOI: 10.3969/j.issn.1001-5256.2019.11.006 中华医学会肝病学分会. 肝硬化诊治指南[J]. 临床肝胆病杂志, 2019, 35(11): 2408-2425. DOI: 10.3969/j.issn.1001-5256.2019.11.006
[9]	NERY F, CHEVRET S, CONDAT B, et al. Causes and consequences of portal vein thrombosis in 1, 243 patients with cirrhosis: Results of a longitudinal study[J]. Hepatology, 2015, 61(2): 660-667. DOI: 10.1002/hep.27546
[10]	OOI K, SHIRAKI K, SAKURAI Y, et al. Clinical significance of abnormal lipoprotein patterns in liver diseases[J]. Int J Mol Med, 2005, 15(4): 655-660. http://europepmc.org/abstract/MED/15754028
[11]	CHEN S, YIN P, ZHAO X, et al. Serum lipid profiling of patients with chronic hepatitis B, cirrhosis, and hepatocellular carcinoma by ultra fast LC/IT-TOF MS[J]. Electrophoresis, 2013, 34(19): 2848-2856.
[12]	ZHAO J, ZHAO Y, WANG H, et al. Association between metabolic abnormalities and HBV related hepatocelluar carcinoma in Chinese: A cross-sectional study[J]. Nutr J, 2011, 10: 49. DOI: 10.1186/1475-2891-10-49
[13]	FIMOGNARI FL, DE SANTIS A, PICCHERI C, et al. Evaluation of D-dimer and factor Ⅷ in cirrhotic patients with asymptomatic portal venous thrombosis[J]. J Lab Clin Med, 2005, 146(4): 238-243. DOI: 10.1016/j.lab.2005.06.003
[14]	WANG Y, SHI Y, DONG Y, et al. Clinical risk factors of asymptomatic deep venous thrombosis in patients with acute stroke[J]. Clin Appl Thromb Hemost, 2019, 25: 1076029619868534. http://www.researchgate.net/publication/335325676_clinical_risk_factors_of_asymptomatic_deep_venous_thrombosis_in_patients_with_acute_stroke
[15]	ROULEAU P, GUERTIN PA. Early changes in deep vein diameter and biochemical markers associated with thrombi formation after spinal cord injury in mice[J]. J Neurotrauma, 2007, 24(8): 1406-1414. DOI: 10.1089/neu.2006.0260
[16]	OKANO K, SHITAMOTO K, ARAKI M, et al. Influencing factors in quantitative measurement using activated platelet levels and platelet-activating capacity for the assessment of thrombosis in pre-metabolic syndrome and type 2 diabetes mellitus[J]. Nurs Health Sci, 2018, 20(1): 69-78. DOI: 10.1111/nhs.12389
[17]	YANG J, ZHOU X, FAN X, et al. mTORC1 promotes aging-related venous thrombosis in mice via elevation of platelet volume and activation[J]. Blood, 2016, 128(5): 615-624. DOI: 10.1182/blood-2015-10-672964
[18]	ZHOU J, XU E, SHAO K, et al. Circulating platelet-neutrophil aggregates as risk factor for deep venous thrombosis[J]. Clin Chem Lab Med, 2019, 57(5): 707-715. DOI: 10.1515/cclm-2018-0909
[19]	LYU J, DONG SS, GU HT, et al. TCM syndrome characteristics of portal vein thrombosis in patients with liver cirrhosis and related risk factors[J]. J Clin Hepatol, 2019, 35(10): 2210-2213.(in Chinese) DOI: 10.3969/j.issn.1001-5256.2019.10.016 吕靖, 董思思, 顾宏图, 等. 肝硬化并发门静脉血栓的危险因素及中医证候特点[J]. 临床肝胆病杂志, 2019, 35(10): 2210-2213. DOI: 10.3969/j.issn.1001-5256.2019.10.016
[20]	LI MX, ZHANG XF, LIU ZW, et al. Risk factors and clinical characteristics of portal vein thrombosis after splenectomy in patients with liver cirrhosis[J]. Hepatobiliary Pancreat Dis Int, 2013, 12(5): 512-519. DOI: 10.1016/S1499-3872(13)60081-8
[21]	TRIPODI A, PRIMIGNANI M, CHANTARANGKUL V, et al. An imbalance of pro- vs anti-coagulation factors in plasma from patients with cirrhosis[J]. Gastroenterology, 2009, 137(6): 2105-2111. DOI: 10.1053/j.gastro.2009.08.045
[22]	LINARES I, GOLDARACENA N, ROSALES R, et al. Splenectomy as flow modulation strategy and risk factors of de novo portal vein thrombosis in adult-to-adult living donor liver transplantation[J]. Liver Transpl, 2018, 24(9): 1209-1220. DOI: 10.1002/lt.25212
[23]	IKEDA M, SEKIMOTO M, TAKIGUCHI S, et al. High incidence of thrombosis of the portal venous system after laparoscopic splenectomy: A prospective study with contrast-enhanced CT scan[J]. Ann Surg, 2005, 241(2): 208-216. DOI: 10.1097/01.sla.0000151794.28392.a6
[24]	ABDEL-RAZIK A, MOUSA N, ELHELALY R, et al. De-novo portal vein thrombosis in liver cirrhosis: Risk factors and correlation with the Model for End-stage Liver Disease scoring system[J]. Eur J Gastroenterol Hepatol, 2015, 27(5): 585-592. DOI: 10.1097/MEG.0000000000000325

Relative Articles

[1]	Xinyi LI, Jiaojiao LI, Yingying LI, Honghe WEI, Yufan XIONG, Xinchi ZHANG, Wei SUN, Li CHEN. Establishment of a nomogram model for predicting liver cirrhosis with esophagogastric variceal bleeding based on aspartate aminotransferase-to-platelet ratio index and platelet-albumin-bilirubin score[J]. Journal of Clinical Hepatology, 2024, 40(3): 521-526. doi: 10.12449/JCH240314
[2]	Xinyi LI, Jiaojiao LI, Wei SUN. Establishment and evaluation of a nomogram prediction model for overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in patients with liver cirrhosis and esophagogastric variceal bleeding[J]. Journal of Clinical Hepatology, 2024, 40(8): 1605-1611. doi: 10.12449/JCH240816
[3]	Tianfu LIU, Liang WANG, Lingyi ZHANG. Risk factors for non－neoplastic portal vein thrombosis in patients with liver cirrhosis[J]. Journal of Clinical Hepatology, 2023, 39(9): 2122-2127. doi: 10.3969/j.issn.1001-5256.2023.09.014
[4]	Yanan GUO, Hongtu GU, Changqing ZHAO, Yongping MU, Jili YUAN, Feng XING, Yanyan TAO, Jing LYU, Chenghai LIU. Effect of traditional Chinese medicine on portal vein thrombosis in patients with liver cirrhosis and its medication characteristics[J]. Journal of Clinical Hepatology, 2023, 39(2): 345-351. doi: 10.3969/j.issn.1001-5256.2023.02.014
[5]	Li LIU, Junyi LI, Chunyun LIU, Lixian CHANG, Lihua ZHANG, Hongli HUANG, Yu LUO, Jianpeng GAO. Effect of Ganshuang granule combined with entecavir on portal vein thrombosis in patients with hepatitis B cirrhosis[J]. Journal of Clinical Hepatology, 2022, 38(9): 2020-2026. doi: 10.3969/j.issn.1001-5256.2022.09.015
[6]	Wentao XU, Yue YIN, Yiling LI, Xingshun QI. An excerpt of vascular liver disorders, portal vein thrombosis, and procedural bleeding in patients with liver disease: 2020 practice guidance by the American Association for the Study of Liver Diseases[J]. Journal of Clinical Hepatology, 2021, 37(5): 1042-1044. doi: 10.3969/j.issn.1001-5256.2021.05.013
[7]	Yingying CAO, Tao HAN, Yu ZHANG, Fang LIU, Jing LIANG, Haixia YUAN, Jun LI, Huiling XIANG. Rebleeding and prognosis of patients with liver cirrhosis and severe esophagogastric variceal bleeding[J]. Journal of Clinical Hepatology, 2021, 37(6): 1326-1330. doi: 10.3969/j.issn.1001-5256.2021.06.022
[8]	Zhaopeng LI, Guangchuan WANG, Chunqing ZHANG. Value of transjugular intrahepatic portosystemic shunt in the prevention of esophageal variceal rebleeding in patients with portal vein thrombosis after splenectomy[J]. Journal of Clinical Hepatology, 2021, 37(6): 1331-1335. doi: 10.3969/j.issn.1001-5256.2021.06.023
[9]	Ruan FangMing, Li BiMin. Risk factors for the formation of portal vein thrombosis in patients with liver cirrhosis[J]. Journal of Clinical Hepatology, 2020, 36(1): 182-185. doi: 10.3969/j.issn.1001-5256.2020.01.043
[10]	Sun YaNan, Li Peng, Ding HuiGuo, Zhang ShiBin, Xiong Feng. Risk factors for early rebleeding after initial sclerotherapy for esophageal varices[J]. Journal of Clinical Hepatology, 2019, 35(1): 92-97. doi: 10.3969/j.issn.1001-5256.2019.01.017
[11]	Lyu Jing, Dong SiSi, Gu HongTu, Zhao ZhangQing, Liu ChengHai. TCM syndrome characteristics of portal vein thrombosis in patients with liver cirrhosis and related risk factors[J]. Journal of Clinical Hepatology, 2019, 35(10): 2210-2213. doi: 10.3969/j.issn.1001-5256.2019.10.016
[12]	Ma JiaLi, Li Ping, Wei HongShan, Zhou YuLing, Liang XiuXia, Hu JuLong, Ai ZhengLin, Chen Xu. Risk factors for glue extrusion bleeding after endoscopic therapy for esophagogastric variceal bleeding[J]. Journal of Clinical Hepatology, 2018, 34(1): 89-91. doi: 10.3969/j.issn.1001-5256.2018.01.018
[13]	Cui CanCan, Li DanDan, Li ZhangFeng, Yan ZhenKun, Wang LiQiang, Sun Chen, Zhang Ke, Zhang Bin. Risk factors for early rebleeding after first-time endoscopic variceal ligation[J]. Journal of Clinical Hepatology, 2018, 34(7): 1445-1451. doi: 10.3969/j.issn.1001-5256.2018.07.017
[14]	He Yang, Su YaRong, Han ZiYan. Current status of research on primary and secondary risk factors for esophagogastric variceal rebleeding in patients with liver cirrhosis[J]. Journal of Clinical Hepatology, 2018, 34(7): 1555-1559. doi: 10.3969/j.issn.1001-5256.2018.07.041
[15]	Jin Yan, Wang Xue, Zhang LingJuan, Qiu Ting, Shang BoXin, Lian XiaoYan, Yan ChunYing, Duan TianJiao, Zhang Rong, Liu GuiSheng. Risk factors for early rebleeding after esophageal variceal ligation in patients with liver cirrhosis[J]. Journal of Clinical Hepatology, 2017, 33(11): 2147-2151. doi: 10.3969/j.issn.1001-5256.2017.11.019
[16]	Zhou RenHua, Li Peng, Zhang YanTing, Yang Hua, Yang ShaoQi. Clinical manifestations of portal vein thrombosis and related risk factors in patients with liver cirrhosis[J]. Journal of Clinical Hepatology, 2016, 32(2): 275-278. doi: 10.3969/j.issn.1001-5256.2016.02.015
[17]	Yang ZhengMao, Zhang LingYi. Risk factors for portal vein thrombosis following splenectomy in patients with liver cirrhosis[J]. Journal of Clinical Hepatology, 2015, 31(7): 1173-1175. doi: 10.3969/j.issn.1001-5256.2015.07.044
[18]	Gu Chuan, Li Lu, Wang Jun, Hou FengQin, Xu XiaoYuan. Study on efficacy of endoscopic ligation therapy for esophageal varices and risk factors for postoperative rebleeding[J]. Journal of Clinical Hepatology, 2014, 30(12): 1279-1282. doi: 10.3969/j.issn.1001-5256.2014.12.011
[19]	Yang Hua, Liu YunXia, Li Peng, Yang ShaoQi, Wang YuanZhen. Analysis of risk factors for early rebleeding from esophageal and gastric varices in patients with liver cirrhosis[J]. Journal of Clinical Hepatology, 2014, 30(6): 540-542. doi: 10.3969/j.issn.1001-5256.2014.06.015
[20]	Yang Yan, Fan YanHua, Fang Long, Gao Chun, Du ShiYu, Zhang MingGang, Wang YuanXin, Zhang KeJian. Risk factors of early rebleeding after endoscopic treatment of gastroesophageal varices[J]. Journal of Clinical Hepatology, 2013, 29(3): 178-183.

Supplements(0)

Cited By

Cited by

Periodical cited type(13)

1.	贺鹏志，宁峰. 肝硬化门静脉高压相关并发症的危险因素分析. 中国医学创新. 2024(14): 156-159 .
2.	蒲在春，贾平，刘娟，粟宇霜，郭丹阳，王丽，张勤. 肝硬化门静脉血栓形成风险预测模型的Meta分析. 循证护理. 2024(16): 2869-2874 .
3.	王俊超，汤书豪，方心怡，易根发. 血栓弹力图在肝硬化患者中的应用研究进展. 现代消化及介入诊疗. 2024(10): 1236-1240 .
4.	赵晓飞，曾道炳，栗光明，郭庆良，邸亮，丁兢. 脾切除门奇静脉断流术后肝固有动脉及门静脉的血流动态变化特征. 临床肝胆病杂志. 2023(01): 104-109 . 本站查看
5.	杨莹，石彭宇，张曼曼. 肝硬化门静脉高压合并门静脉血栓行TIPS治疗临床分析. 中国现代普通外科进展. 2023(03): 218-221 .
6.	武幸，张秀军，薛源，薛峰，徐尧，冯静云，陈菲菲. 肝硬化消化道出血患者血抗凝血酶Ⅲ和D-二聚体水平变化及临床意义. 中国肝脏病杂志(电子版). 2023(01): 56-61 .
7.	商宁，黄秀香，田楠楠，陈美玲，叶迎宾，张嫄. 原发性胆汁性胆管炎的肝脏硬度值与脾静动脉血流学参数的相关性分析. 生物医学工程与临床. 2023(03): 286-291 .
8.	商宁，黄秀香，叶迎宾，张嫄. 原发性胆汁性胆管炎肝血流超声参数与肝功能指标的相关性分析. 蚌埠医学院学报. 2023(11): 1573-1576 .
9.	朱秀丽，陈思. 肝硬化门静脉血栓的血清学标志物. 国际消化病杂志. 2022(02): 69-72 .
10.	刘勇，刘振华，徐小兰，舒婷，卢光磊. 琼西地区肝硬化病因流行病学调查及预后影响因素分析. 临床军医杂志. 2022(05): 531-534 .
11.	刘立，李俊义，刘春云，常丽仙，张丽华，黄红丽，罗煜，高建鹏. 肝爽颗粒联合恩替卡韦对乙型肝炎肝硬化患者门静脉血栓发生的影响. 临床肝胆病杂志. 2022(09): 2020-2026 . 本站查看
12.	杨悦军，郑华银，江逸锋. 基于多维度指标构建肝硬化病人食管胃静脉曲张破裂出血后门静脉血栓风险列线图模型及验证. 蚌埠医学院学报. 2022(11): 1533-1538 .
13.	刘倩，张锦，段小霞，栾强强，韩文. 血栓弹力图、常规凝血试验在肝硬化并门静脉血栓中的诊断价值. 中国临床医生杂志. 2021(10): 1181-1185 .

Other cited types(6)

Proportional views

Proportional views

通讯作者: 陈斌, bchen63@163.com

1.
沈阳化工大学材料科学与工程学院沈阳 110142

Figures(2) / Tables(3)

Get Citation

PDF

XML

Article Metrics

Article views (992) PDF downloads(86)

Risk factors of portal vein thrombosis in cirrhotic patients with esophageal varices

DOI: 10.3969/j.issn.1001-5256.2021.01.013