title: Portal vein thrombosis in cirrhosis is not associated with intestinal barrier disruption or increased platelet aggregability.
abstract: OBJECTIVE
  Portal vein thrombosis (PVT) is a common complication of cirrhosis, but its pathogenesis is unclear. We tested the hypotheses that PVT is the result of platelet hyperactivity or intestinal barrier disruption.
  
  
  METHODS
  This study included 49 patients with cirrhosis (15 females) of mixed etiology. Based on spiral computed-tomography, the patients were divided into two groups: with PVT (n=16) and without PVT (n=33). Serum biomarkers of intestinal barrier integrity were endotoxins and zonulin, and platelet activity was assessed with multiple electrode aggregometry.
  
  
  RESULTS
  The levels of endotoxin (43.5±18.3ng/ml vs. 36.9±7.5ng/ml; P=0.19) and zonulin (56.3±31.1ng/ml vs. 69.3±63.1ng/ml; P=0.69) were not different between the patients with and without PVT. Moreover, endotoxin and zonulin did not correlate with the coagulation and platelet parameters. The platelet aggregability measured with the TRAP and the ADP tests was decreased in PVT patients. In the logistic regression analysis the PVT incidence was related to the levels of D-dimer and bilirubin as well as the TRAP test results. Patients with PVT presented with significantly higher levels of D-dimer (4.45±2.59 vs. 3.03±2.97mg/l; P<0.05) and prothrombin levels (175±98.8μg/ml vs. 115±72.9μg/ml; P<0.05) than patients without thrombosis. PVT could be excluded with a 90% negative predictive value when the D-dimer level was below 1.82mg/l.
  
  
  CONCLUSIONS
  Endotoxemia and platelet activity are not determinants of PVT in patients with cirrhosis. The D-dimer measurement has diagnostic significance for PVT in patients with liver cirrhosis.
authors.affiliation: Department of Gastroenterology and Hepatology, School of Medicine in Katowice, Medical University of Silesia, 40-752 Katowice, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Wosiewicz
authors.affiliation: Department of Gastroenterology and Hepatology, School of Medicine in Katowice, Medical University of Silesia, 40-752 Katowice, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Żorniak
authors.affiliation: Department of Gastroenterology and Hepatology, School of Medicine in Katowice, Medical University of Silesia, 40-752 Katowice, Poland. Electronic address: mhartleb@sum.edu.pl.
authors.forename: Marek
authors.initials: M
authors.lastname: Hartleb
authors.affiliation: Department of Epidemiology, School of Medicine in Katowice, Medical University of Silesia, 40-752 Katowice, Poland.
authors.forename: Kamil
authors.initials: K
authors.lastname: Barański
authors.affiliation: Department of Gastroenterology and Hepatology, School of Medicine in Katowice, Medical University of Silesia, 40-752 Katowice, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Hartleb
authors.affiliation: Department of Gastroenterology and Hepatology, School of Medicine in Katowice, Medical University of Silesia, 40-752 Katowice, Poland.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Onyszczuk
authors.affiliation: Department of Radiology and Nuclear Medicine, School of Medicine in Katowice, Medical University of Silesia, 40-752 Katowice, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Pilch-Kowalczyk
authors.affiliation: Department of Hematology and Bone Marrow Transplantation, School of Medicine in Katowice, Medical University of Silesia, 40-752 Katowice, Poland.
authors.forename: Sławomira
authors.initials: S
authors.lastname: Kyrcz-Krzemień
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002772:Cholera Toxin / Q000097:blood*; D004731:Endotoxins / Q000097:blood*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006242:Haptoglobins; D006801:Humans; D007413:Intestinal Mucosa / Q000378:metabolism; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010539:Permeability; D010974:Platelet Aggregation; D011169:Portal Vein / Q000000981:diagnostic imaging; D011498:Protein Precursors; D011516:Prothrombin / Q000032:analysis; D036542:Tomography, Spiral Computed; D020246:Venous Thrombosis / Q000097:blood* / Q000000981:diagnostic imaging
chemical_list: D015415:Biomarkers; D004731:Endotoxins; D005338:Fibrin Fibrinogen Degradation Products; D006242:Haptoglobins; D011498:Protein Precursors; C036309:fibrin fragment D; C408043:zonulin; D011516:Prothrombin; D002772:Cholera Toxin; D001663:Bilirubin