Portosplenomesenteric vein thrombosis in patients with early-stage severe acute pancreatitis

doi:10.3748/wjg.v24.i35.4054

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World Journal of Gastroenterology

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1007-9327

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Retrospective Cohort Study

World J Gastroenterol. Sep 21, 2018; 24(35): 4054-4060
Published online Sep 21, 2018. doi: 10.3748/wjg.v24.i35.4054

Portosplenomesenteric vein thrombosis in patients with early-stage severe acute pancreatitis

Nong-Hua Lu, Yin Zhu, Xiao-Jiang Zhou, Yu-Peng Lei, Xin Huang, Mi Zhou, Liang Xia, Wen-Hua He, Chen Yu, Feng Deng, Ling Ding

Ling Ding, Feng Deng, Mi Zhou, Medical College of Nanchang University, Nanchang 330006, Jiangxi Province, China

Chen Yu, Department of medical image, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China

Wen-Hua He, Liang Xia, Xin Huang, Yu-Peng Lei, Xiao-Jiang Zhou, Yin Zhu, Nong-Hua Lu, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China

Author contributions: Ding L and Deng F designed the study and wrote the manuscript; Yu C reassessed and reviewed patients’ cross-sectional images; Zhou M collected data; He WH, Xia L and Zhou XJ made critical revisions; Huang X and Lei YP interpreted and analyzed data; Zhu Y and Lu NH made substantial contributions to conception, design and coordination of the study and gave final approval of the version to be published. All authors read and approved the final manuscript.

Supported by the National Natural Science Foundation of China, No. 81760120.

Institutional review board statement: This study was approved by the Ethics Committee of the First Affiliated Hospital of Nanchang University.

Informed consent statement: All involved persons gave their informed consent (written or verbal) prior to study inclusion.

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

STROBE statement: The authors have read the STROBE Statemen-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Correspondence to: Yin Zhu, PhD, Professor of Medicine, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 YongWaiZheng Street, Nanchang 330006, Jiangxi Province, China. zhuyin27@sina.com

Telephone: +86-791-88692540 Fax: +86-791-86292217

Received: May 3, 2018
Peer-review started: May 4, 2018
First decision: June 6, 2018
Revised: June 17, 2018
Accepted: June 25, 2018
Article in press: June 25, 2018
Published online: September 21, 2018
Processing time: 139 Days and 17.4 Hours

Abstract

AIM

To investigate the incidence and risk factors of portosplenomesenteric vein thrombosis (PSMVT) in the early stage of severe acute pancreatitis (SAP).

METHODS

Patients with SAP in a tertiary care setting from January 2014 to December 2016 were retrospectively reviewed. All contrast-enhanced computed tomography (CT) studies were reassessed and reviewed. Clinical outcome measures were compared between SAP patients with and without PSMVT in the early stage of the disease. Univariate and multivariate logistic regression analyses were sequentially performed to assess potential risk factors for the development of PSMVT in SAP patients. A receiver operating characteristic (ROC) curve was generated for the qualifying independent risk factors.

RESULTS

Twenty-five of the one hundred and forty (17.86%) SAP patients developed PSMVT 6.19 ± 2.43 d after acute pancreatitis (AP) onset. PSMVT was confirmed by contrast-enhanced CT. Multivariate stepwise logistic regression analyses showed that Balthazar’s CT severity index (CTSI) scores [odds ratio (OR): 2.742; 95% confidence interval (CI): 1.664-4.519; P = 0.000], hypoalbuminemia (serum albumin level < 25 g/L) (OR: 32.573; 95%CI: 2.711-391.353; P = 0.006) and gastrointestinal wall thickening (OR: 4.367, 95%CI: 1.218-15.658; P = 0.024) were independent risk factors for PSMVT developed in patients with SAP. The area under the ROC curve for Balthazar’s CTSI scores was 0.777 (P = 0.000), the sensitivity was 52%, and the specificity was 93% at a cut-off value of 5.5.

CONCLUSION

High Balthazar’s CTSI scores, hypoalbuminemia and gastrointestinal wall thickening are independent risk factors for PSMVT developed in the early stage of SAP.

Keywords: Vascular complication; Portosplenomesenteric vein thrombosis; Severe acute pancreatitis; Early stage; Risk factors; Contrast-enhanced computed tomography

Core tip: Studies on portosplenomesenteric vein thrombosis (PSMVT) occurring in the early stage of acute pancreatitis (AP) were rare. We found that 17.86% of severe AP patients developed PSMVT 6.19 d after AP onset. High Balthazar’s computed tomography severity index (CTSI) scores, hypoalbuminemia and gastrointestinal wall thickening are independent risk factors for the development of PSMVT, and Balthazar’s CTSI scores can predict the occurrence of PSMVT with a high degree of specificity which indicated that a low Balthazar’s CTSI score could be a good indicator that PSMVT would not occur.