Portal Vein Thrombosis Is Associated with an Increased Incidence of Depression and Anxiety Disorders.

Simon Johannes Gairing,Peter Robert Galle,Christian Labenz,Jörn M Schattenberg,Karel Kostev

doi:10.3390/jcm10235689

Abstract

Portal vein thrombosis (PVT) is a severe disease that adversely affects patients’ well-being. Data on the influence of PVT on the occurrence of depression or anxiety disorders are lacking. This study aimed to explore the impact of PVT on the incidence of depression and anxiety disorders diagnoses in a large German primary care cohort over a ten-year period. Patients with PVT were matched to non-PVT individuals by age, sex, yearly consultation frequency, index year and comorbidities in a 1:5 ratio. The primary outcome of the study was the incidence of depression and anxiety disorders. The relationship between PVT and both depression and anxiety disorders was investigated using Cox regression models. We compared 547 patients with PVT with 2735 matched individuals without PVT. Within 5 years of the index date, 17.4% of patients with PVT and 9.3% of non-PVT individuals were diagnosed with depression (p < 0.001). Anxiety disorders were diagnosed in 5.5% and 3.0% of patients with PVT and non-PVT individuals, respectively (p = 0.002). On regression analyses, PVT was positively associated with incident depression (HR 2.01, 95% CI 1.53–2.64, p < 0.001) as well as anxiety disorders (HR 2.16, 95% CI 1.35–3.46, p = 0.001). Regarding depression, this association remained significant in women as well as in men. There was no association between PVT and the incidence of anxiety disorders in women. In conclusion, PVT is associated with the development of depression and anxiety disorders. However, further prospective studies are needed to confirm our findings before definitive recommendations can be made.

Highlights

Portal vein thrombosis (PVT) is a frequent and often severe complication in patients with liver cirrhosis, with a prevalence ranging from 10% to 25% [1,2,3]
Depending on whether the PVT occurs acutely or chronically, clinical presentation ranges from abdominal symptoms to portal hypertension-driven complications such as ascites or esophageal varices
The latter complications are comparable to the disease burden caused by liver cirrhosis-related portal hypertension [5]

Summary

Introduction

Portal vein thrombosis (PVT) is a frequent and often severe complication in patients with liver cirrhosis, with a prevalence ranging from 10% to 25% [1,2,3]. Depending on whether the PVT occurs acutely or chronically, clinical presentation ranges from abdominal symptoms to portal hypertension-driven complications such as ascites or esophageal varices. The latter complications are comparable to the disease burden caused by liver cirrhosis-related portal hypertension [5]. According to the European Health Interview Survey 2, which includes data from 28 European Union member states and was collected between 2013–2015, the prevalence of depressive symptoms in Germany was significantly higher with 9.2% compared to the European Union average of 6.6% [8]. In addition to its adverse impact on quality of life, depression represents an increasingly important public health burden [4,5]

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Results