title: The effect of chronic liver disease on venous thromboembolism among medically managed patients in Singapore General Hospital.
abstract: BACKGROUND
  Chronic liver disease (CLD) has been suggested to be associated with venous thromboembolism (VTE) in western populations. However, little is known about the risk effects of CLD on VTE among Asians.
  
  
  OBJECTIVE
  To compute the prevalence of VTE among hospitalised Asian patients, and to evaluate the pattern and scale of risk effects of CLD on VTE occurrence.
  
  
  METHODS
  Retrospective study of hospital discharge database from 2004 to 2011 to identify patients with VTE and CLD using International Statistical Classification of Diseases and Related Health Problems, 9th Revision, Australian Modification (ICD-9-AM) codes.
  
  
  RESULTS
  Of 199904 medically managed inpatients during the 8years, 1744 (0.9%) patients had VTE. Patients with CLD had significant higher prevalence of VTE (non-cirrhosis CLD 1.5%, cirrhosis 2.0%) than patients without CLD (0.8%, p<0.001). In the logistic regression analyses, non-cirrhosis CLD (odds ratio, OR 1.4, 95% CI 1.2-1.7, p<0.001) and cirrhosis (OR 1.5, 95% CI 1.2-2.0, p=0.002) were significant predictors of VTE after adjustment for age, gender, ethnicity, hospital long stayer, cancer, infectious disease, and other comorbid conditions such as diabetic mellitus, anaemia, and cardiovascular, cerebrovascular, renal and pulmonary diseases.
  
  
  CONCLUSIONS
  CLD, particular liver cirrhosis, increases the risks of VTE in hospitalised Asian patients. As CLD patients are perceived to be at risks of bleeding due to the prolonged clotting times and thrombocytopenia, the results of this study brings attention to opposite end of the haemostatic pendulum in patients with chronic liver disease.
authors.affiliation: Department of Epidemiology, Singapore General Hospital, Outram Road, 169608, Singapore; Centre for Quantitative Medicine, Office of Clinical Sciences, Duke-NUS Graduate Medical School, 8 College Road, 169857, Singapore. Electronic address: yang.yong@sgh.com.sg.
authors.forename: Yong
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Epidemiology, Singapore General Hospital, Outram Road, 169608, Singapore.
authors.forename: Xiao Zhu
authors.initials: XZ
authors.lastname: Zhang
authors.affiliation: CEO's Office, Singapore General Hospital, Outram Road, 169608, Singapore.
authors.forename: Han Seong
authors.initials: HS
authors.lastname: Ng
authors.affiliation: Healthcare Analytics, Integrated Health Information Systems (IHIS), SingHealth Corporate Office, 6 Serangoon North Ave 5, 554910, Singapore.
authors.forename: Jeffrey Chern Hui
authors.initials: JC
authors.lastname: Fong
authors.affiliation: Department of Haematology, Singapore General Hospital, Outram Road, 169608, Singapore.
authors.forename: Lai Heng
authors.initials: LH
authors.lastname: Lee
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D002908:Chronic Disease; D015897:Comorbidity; D005260:Female; D006769:Hospitals, General / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008107:Liver Diseases / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D017678:Sex Distribution; D012846:Singapore / Q000453:epidemiology; D015996:Survival Rate; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*
keywords: ICD-9-AM; chronic liver disease; risk factor; venous thromboembolism