Study of Factors Associated with Concomitant Gastrointestinal Bleeding in Patients with Portal Vein Thrombosis in Liver Cirrhosis

Abstract

Background Both portal vein thrombosis (PVT) and gastrointestinal bleeding are complications in patients with liver cirrhosis, and PVT can aggravate the risk of gastrointestinal bleeding, but the conflicting treatment of both is another challenge in clinical work. Objective To investigate the clinical characteristics and risk factors of concomitant gastrointestinal bleeding in patients with PVT in liver cirrhosis. Methods A total of 279 patients diagnosed with PVT in liver cirrhosis at the First Affiliated Hospital of Kunming Medical University from 2016-10-01 to 2021-09-30 were retrospectively collected and divided into the bleeding group (n=127) and non-bleeding group (n=152) according to the presence of gastrointestinal bleeding symptoms of hematemesis and melena in this admission. The differences in general information, complications, laboratory and imaging tests, surgical history and other relevant information between the two groups were compared. Multivariate Logistic regression analysis was used to explore the influencing factors of the complications of gastrointestinal bleeding in cirrhotic patients with PVT. Results A total of 5 807 patients were retrospectively investigated in the study, including 350 patients combined with PVT with a incidence of 6.0%. PVT was most common in 279 cirrhotic patients with PVT complicated by liver function Child B grade[146 (52.3%) ]. There were significant differences in etiology, vascular involvement, jaundice, internal diameter of main portal vein, gastroesophageal varices, white blood cell (WBC), blood urea nitrogen (BUN), hemoglobin (Hb), hematocrit (HCT), total bilirubin (TBiL), fibrinogen (FIB), and history of laparotomy between the bleeding group and non-bleeding group (P<0.05). Multivariate Logistic regression analysis showed that elevated WBC level (OR=2.555, 95%CI=1.318-6.542), decreased HCT level (OR=0.511, 95%CI=0.247-0.925), decreased FIB level (OR=0.085, 95%CI=0.005-0.661), and involvement of superior mesenteric vein thrombosis (OR=27.873, 95%CI=1.452-1 335.715) were independent risk factors for concomitant gastrointestinal bleeding in cirrhotic patients with PVT (P<0.05) . Conclusion Elevated WBC level, decreased HCT level, decreased FIB level and involvement of superior mesenteric vein thrombosis are independent risk factors for gastrointestinal bleeding in cirrhotic patients with PVT, and early intervention should be implemented to improve the prognosis.

Keywords

• liver cirrhosis|portal vein thrombosis|gastrointestinal bleeding|risk factors