Thromboembolism in Hospitalized Cirrhotic Patients

Abstract

Introduction: Liver disease resets the coagulation hemostasis; leaving the liver cirrhotic individuals at increased risk of bleeding as well as thrombosis. The liver is involved not only in producing coagulation factors, but it also synthesizes anticoagulation factors. The outcome of the study is to investigate the difference between mortality of acute pulmonary embolism and lower extremity deep thrombosis in hospitalized cirrhotic versus noncirrhotic patients. Methods: We performed a retrospective analysis using the de-identified patient data from the national health database, NIS-HCUP, derived from the Nationwide Inpatient Sample (NIS) between January 1, 2014, and December 31, 2014. The incidence of acute pulmonary embolism and lower extremity deep thrombosis was calculated in both cirrhotic and noncirrhotic patients. Hospital visits with the diagnosis of acute pulmonary embolism and lower extremity deep thrombosis were identified using ICD-9 code included in the study. There was further classified based on liver cirrhosis: acute pulmonary embolism and lower extremity deep thrombosis and cirrhotic (case group) and acute pulmonary embolism and lower extremity deep thrombosis in non-cirrhotic patients (control-group). Results: A total of 161,822 admissions (2.3%) for cirrhotic patients and 6909940 (97.7%) for non-cirrhotic patients during the study period. The incidence of acute pulmonary embolism and acute lower extremity deep venous thrombosis was 76475 (1.1%) in the whole cohort. This included 1550 (1%) cases of PE and/or DVT identified in cirrhotic group and 74925 (1.1%) in non-cirrhotic group. The odds of having thrombosis was 0.88 times less in cirrhotic versus non-cirrhotic patients (confidence interval 0.84-0.93). Mortality in cirrhotic patinet with DVT/PE was 142 (9.2%) versus 4645 (6.2%) in noncirrhotic group (OR 1.52, 1.28-1.81). Conclusion: Although cirrhotic patients were found to have lower odds of developing blood clots, they had higher mortality as compared to non-cirrhotic patients. Patients with liver cirrhosis had a longer hospital stay; more hospital cost spent on the admission and more number of diagnoses on discharge as compared to non-cirrhotic patients.