Portal Vein Thrombosis in Patients with Liver Cirrhosis: What Went Wrong?

Abstract

Doina Georgescu,1,* Oana-Elena Ancusa,1 Daniel Azoulay,2,* Ana Lascu,3 Ioana Ionita,1 Despina Calamar-Popovici,1 Mihai Ionita,1 Ciprian Ilie Rosca,1 Gelu-Mihai Brează,4 Daniela Reisz,5 Daniel Lighezan1 1Center of Advanced Researches in Cardiovascular Diseases and Hemostaseology, Department of Internal Medicine I, “V Babes” University of Medicine and Pharmacy, Timisoara, Romania; 2Hepato-Biliary Center, Paul-Brousse Hospital, Paris-Saclay University, Villejuif, France; 3Department of Functional Sciences, “V Babes” University of Medicine and Pharmacy, Timisoara, Romania; 4Department IX of Surgery I, Compartment of Hepatic-Biliary-Pancreatic Surgery, “V Babes” University of Medicine and Pharmacy, Timisoara, Romania; 5Department of Neurosciences, “V Babes” University of Medicine and Pharmacy, Timisoara, Romania*These authors contributed equally to this workCorrespondence: Oana-Elena Ancusa, Center of Advanced Researches in Cardiovascular Diseases and Hemostaseology, Department of Internal Medicine I,“V Babes” University of Medicine and Pharmacy, 2 Piata Eftimie Murgu, Timisoara, Timis, 300041, Romania, Tel [phone], Fax [phone], Email [email protected]: This study aimed to explore inflammatory biomarkers, stool’s functional bacterial groups and their possible link to portal vein thrombosis (PVT) in patients with liver cirrhosis (LC).Materials and Methods: An observational study of 300 participants: 200 inhospital cirrhotic patients, who met inclusion criteria, equally assigned into two groups, based on the presence or absence of PVT and 100 healthy controls was carried out.Results: The PVT group displayed significant differences related to older age, cigarettes smoking history, emergency admission, higher Child-Pugh score, metabolic related disorders and nonalcoholic fatty liver disease, as well as non-obstructive aspects, with chronic thrombi. The PVT group exhibited significant differences related to biomarkers such as tumor necrosis factor (TNF)-alpha, C-reactive protein (CRP), D-dimers (D-D), as well as gut overall dysbiosis (DB) and alteration of different functional bacterial groups of the gut microbiota. Strong positive correlations were observed between PVT severity, and TNF-alpha, CRP, D-D as well as lipopolysaccharide (LPS) positive bacteria. Esophageal varices, age and abdominal pain were independent predictors for PVT severity as well as CRP, TNF-alpha and D-D.Conclusion: Patients with LC and PVT displayed elevation of TNF-alpha, CRP, D-D alterations of the functional gut microbiota, as well as several morphological and clinical particularities. Although the LPS positive gut microbiota was linked to inflammatory biomarkers and PVT severity, it was not proven to be an independent predictor of the PVT severity like CRP, TNF-alpha and D-D.Graphical Abstract: Keywords: portal vein obstruction, end stage liver disease, biomarkers, gut functional bacteria

Keywords

• portal vein obstruction
• end stage liver disease
• biomarkers
• gut functional bacteria