Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Nov 28, 2015; 7(27): 2774-2780
Published online Nov 28, 2015. doi: 10.4254/wjh.v7.i27.2774
Portal vein thrombosis, mortality and hepatic decompensation in patients with cirrhosis: A meta-analysis
Jonathan G Stine, Puja M Shah, Scott L Cornella, Sean R Rudnick, Marwan S Ghabril, George J Stukenborg, Patrick G Northup
Jonathan G Stine, Sean R Rudnick, Patrick G Northup, Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, VA 22908, United States
Puja M Shah, Department of Surgery, University of Virginia, Charlottesville, VA 22908, United States
Scott L Cornella, Department of Medicine, University of Virginia, Charlottesville, VA 22908, United States
Marwan S Ghabril, Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, IN 46202, United States
George J Stukenborg, Department of Public Health Science, University of Virginia, Charlottesville, VA 22908, United States
Author contributions: Stine JG and Shah PM contributed equally to this work; Stine JG, Shah PM, Ghabril MS, Stukenborg GJ and Northup PG designed research; Stine JG, Shah PM, Cornella SL and Rudnick SR performed research; Stine JG and Shah PM analyzed data; Stine JG, Shah PM, Cornella SL, Rudnick SR, Ghabril MS, Stukenborg GJ and Northup PG wrote the paper.
Supported by (In part) grant funding from the National Institutes of Health (Grant 5T32DK007769-15); and NIH-Surgical Oncology grant (T32 CA163177).
Conflict-of-interest statement: We have no conflicts of interest to report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jonathan G Stine, MD, MSc, Division of Gastroenterology and Hepatology, University of Virginia, JPA and Lee Street, MSB 2145, PO Box 800708, Charlottesville, VA 22908, United States. jgs9f@virginia.edu
Telephone: +1-434-9242959 Fax: +1-434-2447529
Received: September 18, 2015
Peer-review started: September 19, 2015
First decision: October 21, 2015
Revised: November 2, 2015
Accepted: November 10, 2015
Article in press: November 11, 2015
Published online: November 28, 2015
Processing time: 70 Days and 5.9 Hours
Abstract

AIM: To determine the clinical impact of portal vein thrombosis in terms of both mortality and hepatic decompensations (variceal hemorrhage, ascites, portosystemic encephalopathy) in adult patients with cirrhosis.

METHODS: We identified original articles reported through February 2015 in MEDLINE, Scopus, Science Citation Index, AMED, the Cochrane Library, and relevant examples available in the grey literature. Two independent reviewers screened all citations for inclusion criteria and extracted summary data. Random effects odds ratios were calculated to obtain aggregate estimates of effect size across included studies, with 95%CI.

RESULTS: A total of 226 citations were identified and reviewed, and 3 studies with 2436 participants were included in the meta-analysis of summary effect. Patients with portal vein thrombosis had an increased risk of mortality (OR = 1.62, 95%CI: 1.11-2.36, P = 0.01). Portal vein thrombosis was associated with an increased risk of ascites (OR = 2.52, 95%CI: 1.63-3.89, P < 0.001). There was insufficient data available to determine the pooled effect on other markers of decompensation including gastroesophageal variceal bleeding or hepatic encephalopathy.

CONCLUSION: Portal vein thrombosis appears to increase mortality and ascites, however, the relatively small number of included studies limits more generalizable conclusions. More trials with a direct comparison group are needed.

Keywords: Hepatology; Coagulopathy; Liver; Ascites; Hepatic encephalopathy; Portal hypertension

Core tip: Portal vein thrombosis (PVT) is a common complication of cirrhosis with resultant downstream hepatic decompensation and mortality. Treatment options carry risk and are not without complications. To date, there is a lack of systematic evidence on the clinical importance of PVT. We performed a systematic review and meta-analysis to determine the aggregate estimates of effect of PVT on hepatic decompensation and mortality. PVT appears to significantly increase mortality (OR = 1.62, 95%CI: 1.11-2.36) and ascites (OR = 2.52, 95%CI: 1.63-3.89), however, the small number of included studies limits more generalizable conclusions. More trials with a direct comparison group are needed.