993 Trends of Portal Vein Thrombosis Comorbidities Among Decompensated Cirrhosis in a Nationwide Inpatient Cohort

Abstract

INTRODUCTION: Portal vein thrombosis (PVT) is commonly associated with cirrhosis. Previous studies showed increasing PVT prevalence but declining PVT mortality in decompensated cirrhosis. However, the trends of PVT associated comorbidities have not been well studied in this population. METHODS: We conducted a retrospective cohort study utilizing the 2000-2014 National Inpatient Sample (NIS) Database. Patients older than 18 years with decompensated cirrhosis were included, defined by an ICD-9-CM coding for cirrhosis plus a decompensating event or portal hypertensive sequelae. Those who had liver transplantation or hepatocellular carcinoma were excluded. We further grouped patients with alcoholic cirrhosis vs non-alcoholic cirrhosis. The primary outcomes included the trends of esophageal variceal bleeding, acute kidney injury (AKI), and mesenteric ischemia. The secondary outcome was trend of transjugular intrahepatic portosystemic shunt (TIPS) in cirrhosis with PVT. Analysis was performed using Cochran-Armitage test and further adjusted by patients' age, sex, and race. RESULTS: The total number of hospitalizations with decompensated cirrhosis and PVT was 51,925. During years 2000 to 2014, among all-cause decompensated cirrhosis with PVT, AKI prevalence increased from 12.6% to 33.3% (OR 1.09, P < 0.001), mesenteric ischemia prevalence increased from 5.5% to 9.2% (OR 1.06, P < 0.001), esophageal variceal bleed prevalence declined from 27.7% to 13.0% (OR 0.96, P < 0.001), and TIPS rate declined from 8.7% to 4.2% (OR 0.96, P = 0.001). These results remained statistically significant after adjusting for patients’ age, sex, and race. Subgroup analysis showed similar trends in alcoholic and non-alcoholic cirrhosis, though the declining prevalence rates of esophageal variceal bleed and TIPS in alcoholic cirrhosis did not reach statistical significance after adjustment. CONCLUSION: Among decompensated cirrhosis complicated by PVT, prevalence of AKI and mesenteric ischemia was found to be rising. Advancements in radiologic imaging technologies may explain increased detection of mesenteric ischemia. Esophageal variceal bleeding and TIPS prevalence were found to be decreasing, likely due to widespread utilization of endoscopy for primary and secondary prophylaxis of variceal hemorrhage. Given ongoing evidence supporting the safety of direct oral anticoagulants for treatment of PVT in cirrhosis, the utilization of TIPS for therapy of nonocclusive and localized PVT is likely to decline.