title: Splenectomy Causes 10-Fold Increased Risk of Portal Venous System Thrombosis in Liver Cirrhosis Patients.
abstract: BACKGROUND Portal venous system thrombosis (PVST) is a life-threatening complication of liver cirrhosis. We conducted a retrospective study to comprehensively analyze the prevalence and risk factors of PVST in liver cirrhosis. MATERIAL AND METHODS All cirrhotic patients without malignancy admitted between June 2012 and December 2013 were eligible if they underwent contrast-enhanced CT or MRI scans. Independent predictors of PVST in liver cirrhosis were calculated in multivariate analyses. Subgroup analyses were performed according to the severity of PVST (any PVST, main portal vein [MPV] thrombosis >50%, and clinically significant PVST) and splenectomy. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported. RESULTS Overall, 113 cirrhotic patients were enrolled. The prevalence of PVST was 16.8% (19/113). Splenectomy (any PVST: OR=11.494, 95%CI=2.152-61.395; MPV thrombosis >50%: OR=29.987, 95%CI=3.247-276.949; clinically significant PVST: OR=40.415, 95%CI=3.895-419.295) and higher hemoglobin (any PVST: OR=0.974, 95%CI=0.953-0.996; MPV thrombosis >50%: OR=0.936, 95%CI=0.895-0.980; clinically significant PVST: OR=0.935, 95%CI=0.891-0.982) were the independent predictors of PVST. The prevalence of PVST was 13.3% (14/105) after excluding splenectomy. Higher hemoglobin was the only independent predictor of MPV thrombosis >50% (OR=0.952, 95%CI=0.909-0.997). No independent predictors of any PVST or clinically significant PVST were identified in multivariate analyses. Additionally, PVST patients who underwent splenectomy had a significantly higher proportion of clinically significant PVST but lower MELD score than those who did not undergo splenectomy. In all analyses, the in-hospital mortality was not significantly different between cirrhotic patient with and without PVST. CONCLUSIONS Splenectomy may increase by at least 10-fold the risk of PVST in liver cirrhosis independent of severity of liver dysfunction.
authors.affiliation: Liver Cirrhosis Group, Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, Liaoning, China (mainland).
authors.forename: Xingshun
authors.initials: X
authors.lastname: Qi
authors.affiliation: Department of Liver Diseases and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China (mainland).
authors.forename: Guohong
authors.initials: G
authors.lastname: Han
authors.affiliation: Department of General Surgery, General Hospital of Shenyang Military Area, Shenyang, Liaoning, China (mainland).
authors.forename: Chun
authors.initials: C
authors.lastname: Ye
authors.affiliation: Liver Cirrhosis Group, Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, Liaoning, China (mainland).
authors.forename: Yongguo
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Liver Cirrhosis Group, Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, Liaoning, China (mainland).
authors.forename: Junna
authors.initials: J
authors.lastname: Dai
authors.affiliation: Liver Cirrhosis Group, Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, Liaoning, China (mainland).
authors.forename: Ying
authors.initials: Y
authors.lastname: Peng
authors.affiliation: Liver Cirrhosis Group, Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, Liaoning, China (mainland).
authors.forename: Han
authors.initials: H
authors.lastname: Deng
authors.affiliation: Liver Cirrhosis Group, Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, Liaoning, China (mainland).
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.affiliation: Liver Cirrhosis Group, Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, Liaoning, China (mainland).
authors.forename: Feifei
authors.initials: F
authors.lastname: Hou
authors.affiliation: Liver Cirrhosis Group, Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, Liaoning, China (mainland).
authors.forename: Zheng
authors.initials: Z
authors.lastname: Ning
authors.affiliation: Liver Cirrhosis Group, Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, Liaoning, China (mainland).
authors.forename: Jiancheng
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Liver Cirrhosis Group, Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, Liaoning, China (mainland).
authors.forename: Xintong
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Liver Cirrhosis Group, Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, Liaoning, China (mainland).
authors.forename: Ran
authors.initials: R
authors.lastname: Wang
authors.affiliation: Liver Cirrhosis Group, Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, Liaoning, China (mainland).
authors.forename: Xiaozhong
authors.initials: X
authors.lastname: Guo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000473:pathology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013156:Splenectomy / Q000009:adverse effects*; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology