Splanchnic vein thrombosis associated with SARS-CoV-2 infection: A VALDIG case–control study
Pierre Deltenre,
Audrey Payancé,
Laure Elkrief,
Vincenzo La Mura,
Florent Artru,
Anna Baiges,
Jean-Paul Cervoni,
Louise China,
Isabelle Colle,
Elise Lemaitre,
Bogdan Procopet,
Dietmar Schiller,
Christophe Bureau,
Odile Goria,
Isabelle Ollivier,
Alexandre Nuzzo,
Pierre-Emmanuel Rautou,
Aurélie Plessier
Affiliations
Pierre Deltenre
CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; Clinique St Luc, Bouge, Belgium; CHU UCL Namur, Université Catholique de Louvain, Yvoir, Belgium; Corresponding author. Address: Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, C.U.B. Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium. Tel.: +32 2 555 31 11.
Audrey Payancé
Université de Paris, AP-HP, Hôpital Beaujon, Service d'Hépatologie, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, ERN RARE-LIVER, VALDIG Group, Centre de recherche sur l'inflammation, Inserm, UMR 1149, Paris, France
Laure Elkrief
Hôpital Trousseau, CHU de Tours, FILFOIE, ERN RARE-LIVER, VALDIG Group, Tours, France
Vincenzo La Mura
IRCCS Fondazione Ca' Granda – Ospedale Maggiore Policlinico, ERN RARE-LIVER, VALDIG Group, Milan, Italy
Florent Artru
Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
Anna Baiges
Barcelona Hepatic Hemodynamic Lab, Clinic Barcelona Hospital, CIBEREHD, IDIBAPS, Universitat de Barcelona, ERN RARE-LIVER, VALDIG Group, Barcelona, Spain
Jean-Paul Cervoni
CHU, Besançon, France
Louise China
Royal Free Hospital, London, UK
Isabelle Colle
Algemeen Stedelijk Ziekenhuis ASZ, Aalst, Belgium
Elise Lemaitre
CHU, Lille, France
Bogdan Procopet
Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
Dietmar Schiller
Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria
Hôpital Universitaire Charles Nicolle de Rouen, Rouen, France
Isabelle Ollivier
Hôpital Universitaire Côte de la Nacre, FILFOIE, ERN RARE-LIVER, VALDIG Group, Caen, France
Alexandre Nuzzo
Paris Cité University, AP-HP, Beaujon Hospital, Intestinal Stroke Center, Gastroenterology, IBD, Intestinal Failure Department, Inserm, UMR 1148, Paris, France
Pierre-Emmanuel Rautou
Université de Paris, AP-HP, Hôpital Beaujon, Service d'Hépatologie, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, ERN RARE-LIVER, VALDIG Group, Centre de recherche sur l'inflammation, Inserm, UMR 1149, Paris, France
Aurélie Plessier
Université de Paris, AP-HP, Hôpital Beaujon, Service d'Hépatologie, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, ERN RARE-LIVER, VALDIG Group, Centre de recherche sur l'inflammation, Inserm, UMR 1149, Paris, France
Background & Aims: Whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is a risk factor for splanchnic vein thrombosis (SVT) is unknown. This study aims to assess the impact of SARS-CoV-2 infection on the presentation and prognosis of recent SVT and to identify specific characteristics of SARS-CoV-2-associated SVT. Methods: This is a retrospective study collecting health-related data of 27 patients presenting with recent SVT in the context of SARS-CoV-2 infection in 12 Vascular Liver Disease Group (VALDIG) centres and in comparison with 494 patients with recent SVT before the SARS-CoV-2 pandemic. Results: Twenty-one patients with SARS-CoV-2 had portal vein thrombosis with or without thrombosis of another splanchnic vein, two had superior mesenteric vein thrombosis, one had splenic vein thrombosis, and three had hepatic vein thrombosis. Diagnosis of SVT was made 10 days (95% CI 0–24 days) after the diagnosis of SARS-CoV-2 infection. Fever (52 vs. 15%; p <0.001) and respiratory symptoms (44 vs. 0%; p <0.001) were more frequent, and median lymphocyte count was lower (1.1 × 103/mm3 vs. 1.6 × 103/mm3; p = 0.043) in patients with infection than in those without SARS-CoV-2 infection. A prothrombotic condition was identified in 44 and 52% of patients with and without SARS-CoV-2 infection, respectively (p = 0.5). All patients with SARS-CoV-2 received anticoagulation therapy. During a median follow-up of 250 days, three SARS-CoV-2-infected patients (11%) required intestinal resection for infarction 1 to 3 months after diagnosis of SVT compared with 13 (2.6%) controls (p = 0.044). Partial or complete recanalisation of the thrombosed splanchnic vein was performed in 33% of patients with SARS-CoV-2. Conclusions: SARS-CoV-2 infection can be associated with recent SVT. Intestinal infarction leading to intestinal resection might be more frequent in patients with SARS-CoV-2. Impact and implications: SARS-CoV-2 infection can be associated with recent SVT. SVT occurring during SARS-CoV-2 infection is characterised by a higher frequency of respiratory symptoms and a lower lymphocyte count. Intestinal infarction leading to intestinal resection appears to occur more frequently in patients with SARS-CoV-2.
