Introduction: Portal vein thrombosis (PVT) is a frequent complication in patients with cirrhosis. There is limited data on the outcomes of PVT in patients who smoke in relation to cirrhosis. Still, it may also exist as an independent vascular condition without liver damage, such as in prothrombotic states [1]. We aim to determine outcomes in patients diagnosed with PVT who smokes with and without cirrhosis.
Methods: A retrospective analysis was performed by utilizing the National Inpatient Sample database (2016, 2017, and 2018) and the International Classification of Diseases, Tenth Revision codes to identify the patients with the principal diagnosis of PVT and smoking. We assessed the all-cause in-hospital mortality, morbidity, length of hospital stay (LOS), and total costs between groups with and without cirrhosis. Categorical variables were compared using the chi-square test, and continuous variables were compared using the t-test.
Results: We identified 33,314 patients with PVT who are also smokers, of whom 14,991 had cirrhosis, and 18,323 were without cirrhosis. The in-hospital mortality was significantly higher in patients with cirrhosis (OR 2.95, 95% CI 2.40–3.63; P< 0.01). Diabetes (P< 0.01), obesity (P=0.001), cardiovascular comorbidity (P< 0.01), and older age (P=0.02) are identified as predictors of mortality. Patients with PVT and smoking with cirrhosis have high odds of upper GI bleeding (OR 1.87, 95% CI 1.48–2.37; P< 0.01), peritonitis (OR 2.0, 95% CI 3.82–6.82; P< 0.01), and acute kidney injury (OR 2.45, 95% CI 2.18–2.76; P< 0.01). We found that PVT patients with cirrhosis had a longer LOS (6.7 days vs. 6.1 days; P< 0.01) and higher total hospital costs ($12,324 vs. $10,238; P< 0.00).
Discussion: In patients with PVT who are current smokers, cirrhosis is an independent significant risk factor for in-hospital mortality. Cirrhosis has been associated with increased complications like upper GI bleeding, peritonitis, and acute kidney injury in PVT. Mean LOS and resource utilization were also higher in patients with cirrhosis compared to patients without cirrhosis.
1. Intagliata NM, Caldwell SH, Tripodi A. Diagnosis, Development, and Treatment of Portal Vein Thrombosis in Patients With and Without Cirrhosis. Gastroenterology. 2019;156(6):1582- 1599.e1. doi:10.1053/j.gastro.2019.01.265
