Abstract：
OBJECTIVE: Baveno VII workshop recommends management of acute variceal bleeding (AVB) in cirrhotic patients with nonmalignant portal vein thrombosis (PVT) should be performed according to the guidelines for patients without PVT. Nevertheless, whether PVT affects the outcome of patients with cirrhosis and AVB remains unclear. The aim of this study was to assess the clinical impact of PVT on the outcomes in the pre-emptive TIPSS eligible patients with cirrhosis and AVB.
METHODS: From December 2010 to June 2016, 1219 consecutive cirrhotic patients admitted due to AVB with (n = 151; 12.4%) or without PVT (n = 1068; 87.6%), who received drug plus endoscopic treatment (a combination of vasoactive drugs, antibiotics, and endoscopic ligation for AVB, followed by beta-blockers plus variceal ligation for prevention of rebleeding) were retrospectively included. Fine and Gray competing risk regression models were taken to evaluate the impact of PVT on clinical outcomes after adjusting for potential confounders.
RESULTS: During follow-up, 211 patients (17.3%) died, 490 (40.2%) experienced further bleeding, and 78 (6.4%) experienced new or worsening ascites within 1 year. Compared with those without PVT, patients with PVT had a similar risk of mortality (PVT vs no-PVT: 19.9% vs 16.7% at 1 year; adjusted HR 0.88, 95%CI 0.51-1.52, p = 0.653), further bleeding (47.0% vs 39.2% at 1 year, adjusted HR 1.19, 95% CI 0.92-1.53, p = 183), and new or worsening ascites (7.9% vs 9.6%, adjusted HR 0.70, 95% CI 0.39-1.28, p = 0.253) after adjusting for confounders in multivariable models. These findings were consistent across different relevant subgroups and confirmed by propensity score matching analysis.
CONCLUSIONS: Our study showed no evidence that the PVT was associated with an improved or worsened outcome among cirrhotic patients with AVB who received standard treatment.
METHODS: From December 2010 to June 2016, 1219 consecutive cirrhotic patients admitted due to AVB with (n = 151; 12.4%) or without PVT (n = 1068; 87.6%), who received drug plus endoscopic treatment (a combination of vasoactive drugs, antibiotics, and endoscopic ligation for AVB, followed by beta-blockers plus variceal ligation for prevention of rebleeding) were retrospectively included. Fine and Gray competing risk regression models were taken to evaluate the impact of PVT on clinical outcomes after adjusting for potential confounders.
RESULTS: During follow-up, 211 patients (17.3%) died, 490 (40.2%) experienced further bleeding, and 78 (6.4%) experienced new or worsening ascites within 1 year. Compared with those without PVT, patients with PVT had a similar risk of mortality (PVT vs no-PVT: 19.9% vs 16.7% at 1 year; adjusted HR 0.88, 95%CI 0.51-1.52, p = 0.653), further bleeding (47.0% vs 39.2% at 1 year, adjusted HR 1.19, 95% CI 0.92-1.53, p = 183), and new or worsening ascites (7.9% vs 9.6%, adjusted HR 0.70, 95% CI 0.39-1.28, p = 0.253) after adjusting for confounders in multivariable models. These findings were consistent across different relevant subgroups and confirmed by propensity score matching analysis.
CONCLUSIONS: Our study showed no evidence that the PVT was associated with an improved or worsened outcome among cirrhotic patients with AVB who received standard treatment.
摘要：
目的：BavenoVII研讨会建议，肝硬化合并非恶性门静脉血栓形成（PVT）患者的急性静脉曲张出血（AVB）的治疗应按照指南进行。然而，PVT是否影响肝硬化和AVB患者的预后尚不清楚.这项研究的目的是评估PVT对先发制人TIPSS符合条件的肝硬化和AVB患者预后的临床影响。
方法：从2010年12月至2016年6月，1219例因AVB合并（n=151;12.4％）或无PVT（n=1068;87.6％）而连续入院的肝硬化患者，谁接受了药物加内窥镜治疗（血管活性药物的组合，抗生素,AVB的内镜结扎术，随后是β受体阻滞剂加静脉曲张结扎术以预防再出血)。在调整潜在的混杂因素后，采用精细和灰色竞争风险回归模型来评估PVT对临床结局的影响。
结果：随访期间，211例患者（17.3%）死亡，490（40.2%）经历了进一步的出血，78例（6.4％）在1年内出现新的或恶化的腹水。与没有PVT的相比，PVT患者的死亡风险相似（PVTvs无PVT：1年时19.9%vs16.7%；校正HR0.88，95CI0.51-1.52，p=0.653），进一步出血（47.0%vs39.2%在1年，调整后的HR1.19，95%CI0.92-1.53，p=183），和新的或恶化的腹水(7.9%对9.6%，调整后的HR0.70，95%CI0.39-1.28，p=0.253)。这些发现在不同的相关亚组之间是一致的，并通过倾向评分匹配分析得到证实。
结论：我们的研究表明，在接受标准治疗的肝硬化AVB患者中，PVT与预后改善或恶化相关。
方法：从2010年12月至2016年6月，1219例因AVB合并（n=151;12.4％）或无PVT（n=1068;87.6％）而连续入院的肝硬化患者，谁接受了药物加内窥镜治疗（血管活性药物的组合，抗生素,AVB的内镜结扎术，随后是β受体阻滞剂加静脉曲张结扎术以预防再出血)。在调整潜在的混杂因素后，采用精细和灰色竞争风险回归模型来评估PVT对临床结局的影响。
结果：随访期间，211例患者（17.3%）死亡，490（40.2%）经历了进一步的出血，78例（6.4％）在1年内出现新的或恶化的腹水。与没有PVT的相比，PVT患者的死亡风险相似（PVTvs无PVT：1年时19.9%vs16.7%；校正HR0.88，95CI0.51-1.52，p=0.653），进一步出血（47.0%vs39.2%在1年，调整后的HR1.19，95%CI0.92-1.53，p=183），和新的或恶化的腹水(7.9%对9.6%，调整后的HR0.70，95%CI0.39-1.28，p=0.253)。这些发现在不同的相关亚组之间是一致的，并通过倾向评分匹配分析得到证实。
结论：我们的研究表明，在接受标准治疗的肝硬化AVB患者中，PVT与预后改善或恶化相关。
