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Wada Y, Okuda K, Sasaki S, Shimose S, Nishida T, Shimokobe H, Nagao Y, Torigoe T, Hayashi K, Akashi H, Taniwaki S, Imamura T. Impact of MASLD on Portal Vein Thrombosis Following Hepatectomy for Liver Cancer. Cancers (Basel) 2024; 16:3844. [PMID: 39594799 PMCID: PMC11592967 DOI: 10.3390/cancers16223844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Revised: 11/08/2024] [Accepted: 11/13/2024] [Indexed: 11/28/2024] Open
Abstract
Background: Due to the increasing global prevalence of non-alcoholic fatty liver disease (NAFLD), which is closely linked to metabolic disorders, there has been a rise in the number of patients with NAFLD undergoing hepatectomy. The metabolic disorders, as well as NAFLD, increase venous thrombotic risk. NAFLD was recently updated to a new concept of hepatic steatosis: metabolic dysfunction-associated steatotic liver disease (MASLD). We aimed to investigate the impact of MASLD on post-hepatectomy portal vein thrombosis (PH-PVT). Methods: A total of 106 patients who underwent hepatectomy for liver cancer were included. Steatotic liver disease (SLD) was diagnosed using a CT L/S ratio of <1.1. SLD was classified as follows: MASLD, SLD associated with metabolic factors without alcohol consumption; MetALD, SLD with metabolic factors and moderate alcohol consumption; Other SLD, alcohol or other specific etiology of SLD; and No SLD, no hepatic steatosis. Results: PH-PVT was detected in 12/106 patients (11.3%); MASLD, 7/20 (35%); MetALD, 1/5 (20%); Other SLD, 1/13 (8%); and No SLD, 3/68 (4.4%). Multivariate analysis showed that the MASLD group (including MASLD and MetALD) (odds ratio [OR], 9.27) and left lateral sectionectomy (OR, 6.22) were significant independent risk factors for PH-PVT. Additionally, the incidence of PH-PVT was significantly higher in patients with MASLD than in those without SLD, along with metabolic factors, excluding alcohol consumption. Conclusions: MASLD and MetALD were identified as independent and significant risk factors for PH-PVT. Consideration was given to the idea that hepatic steatosis and metabolic dysfunction play synergistic roles in PH-PVT development.
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Affiliation(s)
- Yoshito Wada
- Department of Surgery, Kyoaikai Tobata Kyoritsu Hospital, Kitakyushu 804-0093, Fukuoka, Japan; (Y.W.); (S.S.); (T.N.); (H.S.); (Y.N.); (T.T.); (K.H.); (H.A.); (S.T.); (T.I.)
| | - Koji Okuda
- Department of Surgery, Kyoaikai Tobata Kyoritsu Hospital, Kitakyushu 804-0093, Fukuoka, Japan; (Y.W.); (S.S.); (T.N.); (H.S.); (Y.N.); (T.T.); (K.H.); (H.A.); (S.T.); (T.I.)
| | - Shin Sasaki
- Department of Surgery, Kyoaikai Tobata Kyoritsu Hospital, Kitakyushu 804-0093, Fukuoka, Japan; (Y.W.); (S.S.); (T.N.); (H.S.); (Y.N.); (T.T.); (K.H.); (H.A.); (S.T.); (T.I.)
| | - Shigeo Shimose
- Department of Internal Medicine, Tobata Kyoritsu Hospital, Kitakyushu 804-0093, Fukuoka, Japan;
| | - Takamichi Nishida
- Department of Surgery, Kyoaikai Tobata Kyoritsu Hospital, Kitakyushu 804-0093, Fukuoka, Japan; (Y.W.); (S.S.); (T.N.); (H.S.); (Y.N.); (T.T.); (K.H.); (H.A.); (S.T.); (T.I.)
| | - Hisaaki Shimokobe
- Department of Surgery, Kyoaikai Tobata Kyoritsu Hospital, Kitakyushu 804-0093, Fukuoka, Japan; (Y.W.); (S.S.); (T.N.); (H.S.); (Y.N.); (T.T.); (K.H.); (H.A.); (S.T.); (T.I.)
| | - Yuichi Nagao
- Department of Surgery, Kyoaikai Tobata Kyoritsu Hospital, Kitakyushu 804-0093, Fukuoka, Japan; (Y.W.); (S.S.); (T.N.); (H.S.); (Y.N.); (T.T.); (K.H.); (H.A.); (S.T.); (T.I.)
| | - Takayuki Torigoe
- Department of Surgery, Kyoaikai Tobata Kyoritsu Hospital, Kitakyushu 804-0093, Fukuoka, Japan; (Y.W.); (S.S.); (T.N.); (H.S.); (Y.N.); (T.T.); (K.H.); (H.A.); (S.T.); (T.I.)
| | - Koji Hayashi
- Department of Surgery, Kyoaikai Tobata Kyoritsu Hospital, Kitakyushu 804-0093, Fukuoka, Japan; (Y.W.); (S.S.); (T.N.); (H.S.); (Y.N.); (T.T.); (K.H.); (H.A.); (S.T.); (T.I.)
| | - Hidetoshi Akashi
- Department of Surgery, Kyoaikai Tobata Kyoritsu Hospital, Kitakyushu 804-0093, Fukuoka, Japan; (Y.W.); (S.S.); (T.N.); (H.S.); (Y.N.); (T.T.); (K.H.); (H.A.); (S.T.); (T.I.)
| | - Satoshi Taniwaki
- Department of Surgery, Kyoaikai Tobata Kyoritsu Hospital, Kitakyushu 804-0093, Fukuoka, Japan; (Y.W.); (S.S.); (T.N.); (H.S.); (Y.N.); (T.T.); (K.H.); (H.A.); (S.T.); (T.I.)
| | - Tetsuo Imamura
- Department of Surgery, Kyoaikai Tobata Kyoritsu Hospital, Kitakyushu 804-0093, Fukuoka, Japan; (Y.W.); (S.S.); (T.N.); (H.S.); (Y.N.); (T.T.); (K.H.); (H.A.); (S.T.); (T.I.)
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Stupia R, Lombardi R, Cattazzo F, Zoncapè M, Mantovani A, De Marco L, Mantovani A, Fracanzani AL, Sacerdoti D, Dalbeni A. Prevalence of portal vein thrombosis in non-alcoholic fatty liver disease: a meta-analysis of observational studies. J Thromb Thrombolysis 2024; 57:330-336. [PMID: 38066387 PMCID: PMC10869434 DOI: 10.1007/s11239-023-02912-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2023] [Indexed: 02/16/2024]
Abstract
Portal vein thrombosis (PVT) is a common complication of cirrhosis as a result of portal hypertension and modification in the hemostatic balance. Accumulating evidence now suggests that patients with non-alcoholic fatty liver disease (NAFLD), especially those with advanced forms, have an increased risk of PVT. Hence, we performed a meta-analysis of observational studies to estimate the overall prevalence of PVT in patients with NAFLD and its advanced forms compared with patients with advanced liver diseases from other etiologies. We systematically searched PubMed, Scopus and Web of Science databases from the inception date to December 30th 2022, using predefined keywords, to identify observational studies. Meta-analysis was performed using random-effects modeling. We included five observational studies for a total of 225,571 patients. Of these, 26,840 (11.9%) patients had NAFLD, whereas the PVT prevalence was 8.5% (n = 2,280). When compared with patients with advanced liver diseases from other etiologies, patients with NAFLD and its advanced forms had a higher risk of prevalent PVT (OR 1.34, 100% CI 1.07-1.67 p < 0,01). The between-study heterogeneity was substantial (I2 = 88%). This meta-analysis suggests that compared with patients with advanced liver diseases from other etiologies, patient with NAFLD and its advanced forms had a higher risk of prevalent PVT. Further research is required to understand the complex link between NAFLD/NASH and PVT development.
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Affiliation(s)
- Roberta Stupia
- Section of General Medicine C, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, P.le Scuro 10, 37134, Verona, Italy
- Liver Unit, University and Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy
| | - Rosa Lombardi
- Department of Pathophysiology and Transplantation, Unit of Metabolic and Internal Medicine, University of Milan, Milan, Italy
| | - Filippo Cattazzo
- Section of General Medicine C, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, P.le Scuro 10, 37134, Verona, Italy
- Liver Unit, University and Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy
| | - Mirko Zoncapè
- Liver Unit, University and Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy
| | - Anna Mantovani
- Section of General Medicine C, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, P.le Scuro 10, 37134, Verona, Italy
- Liver Unit, University and Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy
| | - Leonardo De Marco
- Section of General Medicine C, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, P.le Scuro 10, 37134, Verona, Italy
- Liver Unit, University and Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy
| | - Alessandro Mantovani
- Section of Endocrinology, Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy
| | - Anna Ludovica Fracanzani
- Department of Pathophysiology and Transplantation, Unit of Metabolic and Internal Medicine, University of Milan, Milan, Italy
| | - David Sacerdoti
- Liver Unit, University and Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy
| | - Andrea Dalbeni
- Section of General Medicine C, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, P.le Scuro 10, 37134, Verona, Italy.
- Liver Unit, University and Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy.
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Koumar L, Senthamizhselvan K, Barathi D, Verma A, Rao P, Selvaraj J, Sanker V. Portal Vein Thrombosis in Patients With Cirrhosis of the Liver: Prevalence and Risk Factors. Cureus 2023; 15:e50134. [PMID: 38186444 PMCID: PMC10771608 DOI: 10.7759/cureus.50134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
INTRODUCTION Chronic liver disease very often culminates into cirrhosis and its associated complications. One of the serious complications is portal venous thrombosis, which can occur due to a variety of risk factors. One significant factor contributing to portal hypertension is portal vein thrombosis (PVT). In this study, we aimed to investigate the prevalence of PVT among patients with liver cirrhosis in a tertiary hospital and identify the factors associated with this complication. METHODOLOGY This was a cross-sectional observational study of 93 diagnosed liver cirrhosis patients treated at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) hospital in southern India between June 2020 and January 2021. A thorough evaluation of the clinical condition of the patients and associated comorbidities was done. The patients then underwent Doppler ultrasound/CECT/MRI to look for PVT and its extent. The collected data were analyzed using Statistical Product and Service Solutions (SPSS, version 24) (IBM SPSS Statistics for Windows, Armonk, NY). Comparison between two proportions was done using two two-tailed Z-test/Fisher's exact tests. RESULTS Our study found a PVT prevalence of 17.2% in cirrhotic patients, with a higher prevalence of acute PVT than chronic PVT. Ascitic fluid infection, longer duration of cirrhosis, and increased cirrhosis severity were significantly associated with PVT development. We found no significant associations between PVT and gender, hypertension, smoking, diabetes, or the duration of alcohol intake. CONCLUSION This study highlights the importance of early screening for PVT using Doppler USG in all patients diagnosed with cirrhosis. Additionally, anticoagulation therapy for acute PVT may be considered in patients without bleeding risks.
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Affiliation(s)
- Lokesh Koumar
- Cardiology, Wolverhampton Heart and Lung Centre, New Cross Hospital, Wolverhampton, GBR
| | - Kuppusamy Senthamizhselvan
- Medical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Deepak Barathi
- Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Amogh Verma
- Medicine, Rama Medical College Hospital and Research Centre, Hapur, IND
| | - Pallavi Rao
- Internal Medicine, Dr. Rajendra Prasad Government Medical College, Kangra, IND
| | - Jayachandran Selvaraj
- General Internal Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Vivek Sanker
- General Surgery, Noorul Islam Institute of Medical Science and Research Foundation (NIMS Medicity), Trivandrum, IND
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