The impact of bacterial infection on the risk of portal vein thrombosis development in patients with cirrhosis: A post-hoc analysis

IF 4 3区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Simone Di Cola , Jakub Gazda , Stefano Fonte , Lucia Lapenna , Silvia Nardelli , Giulia Cusi , Adriano De Santis , Manuela Merli
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Abstract

Background

Portal vein thrombosis (PVT) is a common complication in liver cirrhosis. Bacterial infections (BIs) may increase PVT risk through bacterial translocation, systemic inflammation, and coagulation dysfunction, but evidence is limited.

Aims

This study investigates the 6-month risk of onset of PVT in patients hospitalized with BIs.

Methods

This post-hoc analysis included 563 cirrhotic patients hospitalized between 2011 and 2021, with or without BIs diagnosis, and followed for 6 months post-discharge. Patients with HCC outside of Milan criteria were excluded. The main endpoint was the onset of PVT, diagnosed via abdominal ultrasound or CT/MRI.

Results

BI was diagnosed in 146 patients (26 %). Forty-seven patients (8.5 %) experienced PVT events within 6 months, including 15 (10 %) with BIs and 32 (7.8 %) without (p = 0.4). Logistic regression showed no significant effect of BI on PVT occurrence (OR 1.35, 95 % CI 0.69–2.54), even after adjusting for confounding factors. However, urinary tract infections were independently associated with higher PVT risk (OR 3.17, 95 % CI 1.05–10.8, p = 0.048). Other infection sites (pneumonia, spontaneous bacterial peritonitis-SBP, spontaneous bacteremia) and isolated microbial strains (n = 77) were not associated with increased PVT risk. When analyzing the population excluding patients with HCC, the risk of developing PVT was significantly higher in patients with previous BI, regardless of the severity of liver disease (OR 2.92, 95 % CI 1.06–8.16).

Conclusions

In this large cohort, BIs did not significantly increase PVT risk within 6 months post-hospitalization in cirrhotic patients. However, when the cohort was reduced to patients without HCC, the risk of PVT appears to be significant.
细菌感染对肝硬化患者门静脉血栓形成风险的影响:事后分析。
背景:门静脉血栓形成是肝硬化的常见并发症。细菌感染(BIs)可能通过细菌易位、全身性炎症和凝血功能障碍增加PVT风险,但证据有限。目的:本研究探讨BIs住院患者6个月发生PVT的风险。方法:这项事后分析包括2011年至2021年间住院的563名肝硬化患者,有或没有BIs诊断,并在出院后随访6个月。不符合米兰标准的HCC患者被排除在外。主要终点是PVT的发作,通过腹部超声或CT/MRI诊断。结果:146例(26%)患者被诊断为BI。47例(8.5%)患者在6个月内发生PVT事件,其中15例(10%)合并BIs, 32例(7.8%)未合并BIs (p = 0.4)。Logistic回归显示,即使校正了混杂因素,BI对PVT的发生也没有显著影响(OR 1.35, 95% CI 0.69-2.54)。然而,尿路感染与较高的PVT风险独立相关(OR 3.17, 95% CI 1.05-10.8, p = 0.048)。其他感染部位(肺炎、自发性细菌性腹膜炎- sbp、自发性菌血症)和分离的微生物菌株(n = 77)与PVT风险增加无关。当分析排除HCC患者的人群时,既往BI患者发生PVT的风险明显更高,与肝脏疾病的严重程度无关(OR 2.92, 95% CI 1.06-8.16)。结论:在这个大型队列中,BIs没有显著增加肝硬化患者住院后6个月内PVT的风险。然而,当队列减少到没有HCC的患者时,PVT的风险似乎是显著的。
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来源期刊
Digestive and Liver Disease
Digestive and Liver Disease 医学-胃肠肝病学
CiteScore
6.10
自引率
2.20%
发文量
632
审稿时长
19 days
期刊介绍: Digestive and Liver Disease is an international journal of Gastroenterology and Hepatology. It is the official journal of Italian Association for the Study of the Liver (AISF); Italian Association for the Study of the Pancreas (AISP); Italian Association for Digestive Endoscopy (SIED); Italian Association for Hospital Gastroenterologists and Digestive Endoscopists (AIGO); Italian Society of Gastroenterology (SIGE); Italian Society of Pediatric Gastroenterology and Hepatology (SIGENP) and Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Digestive and Liver Disease publishes papers on basic and clinical research in the field of gastroenterology and hepatology. Contributions consist of: Original Papers Correspondence to the Editor Editorials, Reviews and Special Articles Progress Reports Image of the Month Congress Proceedings Symposia and Mini-symposia.
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