Ashok Choudhury, Scott Silvey, Florence Wong, Patrick S Kamath, Jacob George, Ramazan Idilman, Mark Topazian, Aldo Torre, Mário Reis Álvares-da-Silva, Qing Xie, Peter Hayes, Wai Kay Seto, Shiv K Sarin, Jacqueline Cordova-Gallardo, Suresh Vasan Venkatachalapathy, Xiangmei Wang, Patricia Zitelli, Hak-Keith Leung, Hibat Allah Belimi, Bin Xu, Francisco Félix-Tellez, Robert Livingstone, Mingqin Lu, Feng Peng, Busra Haktaniyan, Liou Wei Lun, Shalimar, Ashish Goel, K Rajender Reddy, Katina Zheng, Surender Kumar, Mohammad Rela, Ajay Jhaveri, Richard Goodheart, Dinç Dinçer, Kessarin Thanapirom, Henok Fisseha, Yue Wang, Sarai Gonzalez Hueso, Lilian Torres Made, Paula Guedes, Neil Rajoriya, Tao Li, Cameron Gofton, Harendran Elangovan, Gerry MacQuillan, Luis Garrido Trevino, Wei Wang, Stephen Riordan, Dibyalochan Praharaj, Anand V Kulkarni, Nabiha Faisal, Hasan Basri Yapici, Hugo Vargas, Helena Katchman, José Luis Pérez Hérnandez, Feng Guo, Marie Jeanne Lohoues, Ajay Duseja, Kaleb A Berhane, Ahmed Hakem, Huan Deng, Chenghai Liu, Scott W Biggins, Yashwi Haresh Kumar Patwa, Amey Sonavane, Michael Schultheiß, Punita Tandon, Shiva Kumar, Paul Thuluvath, Hong Tang, Xinrui Wang, Robert Gibson, Adrián Gadano, Ewan Marwan, Amany Zekry, Zeki Karasu, Alaa Mostafa, Anil Arora, Ningping Zhang, Cailian Cai, Arun Valsan, Ewan Forrest, Qinglang Xu, Xin Zheng, Hai Li, Yongchao Xian, Andrew Keaveny, Zhiliang Gao, Elizabeth Verna, Yu Jun Wong, Babatunde Duduyemi, Brian J Bush, Jasmohan S Bajaj, CLEARED Consortium
PVT affects one in ten patients in a global inpatient cirrhosis cohort, and independently predicts short-term mortality and major complications, identifying a high-risk subgroup requiring intensified inpatient and post-discharge care.
BACKGROUND: Portal vein thrombosis (PVT) in cirrhosis is associated with adverse outcomes, but determinants of PVT and its impact on short-term outcomes in hospitalized patients across global regions remain unclear.
METHODS: The multinational CLEARED consortium prospectively enrolled adults with cirrhosis admitted non-electively after consent. Patients were followed during hospitalization and 30 days post-discharge. Radiologically diagnosed PVT was analyzed in relation to demography, etiology, clinical features, hospital course, and 30-day outcomes, including mortality.
RESULTS: Among 7,721 patients, etiologies included alcohol related (41.3%), MASH/cryptogenic (24.4%), hepatitis B (19.4%), and hepatitis C (11.3%). PVT was present in 773 patients (10.0%). Prevalence was higher in MASH/cryptogenic and viral cirrhosis compared with alcohol etiology (11.9%, 11.7% vs. 7.3%). Alcohol etiology was associated with lower odds of PVT [OR 0.64 (95% CI 0.5-0.8), p<0.001]. PVT was more common in patients with diabetes (37.4% vs. 28.9%) and in high-income countries (all p<0.001). Independent predictors of PVT included MASH/cryptogenic etiology [OR 1.59 (95% CI 1.2-2.1), p<0.01], prior portal hypertension-related complications (ascites, variceal bleeding, overt HE, hydrothorax), and non-selective beta-blocker use. PVT associated with higher rates of AKI, grade 3-4 hepatic encephalopathy, 30-day readmission, and liver transplantation (all p<0.05). Thirty-day mortality was higher in patients (22.1% vs. 18.0%; p=0.001), and PVT independently predicted mortality (OR 1.5; 95% CI 1.1-1.9; p<0.001).
CONCLUSIONS: PVT affects one in ten patients in a global inpatient cirrhosis cohort, and independently predicts short-term mortality and major complications, identifying a high-risk subgroup requiring intensified inpatient and post-discharge care.