Prevalence and Main Characteristics of Portal Venous System Thrombosis in Patients with Advanced Decompensated Chronic Liver Disease

Introduction and Objectives

Chronic liver disease (CLD) is common globally; in advanced stages, decompensation and complications such as portal venous system thrombosis (PVST) increase.

Objective

To describe the prevalence and main characteristics of hospitalized patients with decompensated CLD and PVST in a tertiary care center.

Materials and Patients

An observational, longitudinal, and descriptive study was conducted on hospitalized patients in a tertiary care center in Mexico City with decompensated CLD during the period 2022 and 2023. These patients had imaging studies (CT scan or hepatic Doppler ultrasound) reporting PVST. Follow-up was conducted from the diagnosis of CLD, documentation of PVST, and survival until 2024. Patients with PVST without a diagnosis of CLD or without current follow-up were excluded.

Data will be analyzed using the SPSS statistical software, version 23. Qualitative variables will be presented as frequencies and percentages, while numerical variables will be shown as means and standard deviations or medians and ranges, as appropriate.

Results

We reviewed 788 records of patients with decompensated CLD, of which 60 had PVST, with a period prevalence of 7.6%. Of this group, 20% had hepatocellular carcinoma. Of the total, 37 were women (61.6%), with an average age of 59 ± 9 years. According to the Child-Pugh classification, 6 cases were class A (10%), 25 were class B (42%), and 29 were class C (48%), with an average MELD score of 19.4 and MELD-Na of 21.8. All patients with PVST had at least one prior decompensation before admission (100%), with 43% and 31% having two and three decompensations, respectively. The most frequent etiology was MASLD (48.3%), and the main reason for hospitalization was variceal gastrointestinal bleeding (50%). The portal vein was the most affected vessel (100%), with 20% of cases showing extension to the superior mesenteric vein, of which 76% presented signs of chronicity. The average time from CLD diagnosis to PVST identification was 3.5 ± 2.83 years. By 2024, 41% of patients with PVST had died, with septic shock being the leading cause of death during hospitalization.

Conclusions

The prevalence of PVST in our study is similar to that reported in the literature (3-25%). It is more frequent in women, has a metabolic etiology, and primarily affects the portal vein. To date, 41% have died, mainly from septic shock. However, PVST may be an important factor to study in the progression of CLD.

Ethical statement: This study was conducted in accordance with the ethical principles of our hospital. All data were handled with strict confidentiality and used solely for research purposes.

Declaration of interests: None.

Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Reviewed Records	F	%
	788
Portal Vein Thrombosis	60	7.6%
Hepatocellular Carcinoma	12	20%
Affected vessel
Portal Vein	60	100%
Superior Mesenteric Vein	13	22%
Inferior Mesenteric Vein	0	0%
Splenic Vein	6	10%
Periodicity of Portal Vein Thrombosis
Recent	17	28.30%
Chronic	43	71.70%
Etiology of Chronic liver disease
Alcohol	19	31.70%
METLAD	3	5%
MASLD	29	48.30%
Viral	4	6.70%
Autoimmune	5	8.30%
Child Pugh
A	6	10%
B	25	41.70%
C	29	48.30%
MELD	19.4 ± 6
MELD NA	21.8 ± 6
Number of prior decompensations
1	60	100%
2	18	30%
3	19	31%
Reasons for Admission
Variceal Hemorrhage	30	50%
Ascites	15	25%
Hepatic Encephalopathy	5	8.30%
Infection	3	5%
Acute Kidney Injury	1	1.70%
Study Protocol	5	8.30%
Cardiogenic Shock	1	1.70%
Average time between CLD diagnosis and PVST		3.5 ± 2.83 años
Death	25	41.7%
Causes of Death
Septic shock	13	52%
Hypovolemic shock	2	8%
Cardiogenic shock	1	4%
Respiratory failure	1	4%
Disease progression	8	32%

CLD: Chronic Liver Disease; MASLD: Metabolic Associated Steatotic Liver Disease; METLAD: Metabolic Liver Disease; MELD: Model for End-Stage Liver Disease; MELD NA: Model for End-Stage Liver Disease without Ascites; PVST: Portal Vein and Splenic Vein Thrombosis.