Reversed portal flow: Clinical influence on the long-term outcomes in cirrhosis

Table 1 Flow direction in the portal venous system n (%)

	Forward portal flow	Non-forward portal flow
		Bidirectional flow	Reversed flow
Total	198 (89.2)	5 (2.3)	19 (8.6)
In portal trunk	-	2 (0.9)	4 (1.8)
In splenic vein	-	5 (2.3)	17 (7.7)
In superior mesenteric vein	-	2 (0.9)	0 (0)

Table 2 Portal hemodynamics using Doppler sonograms n (%)

	Forward portal flow	Non-forward portal flow	P value
Number of subjects	198	24
Portal vein thrombosis (-/+)1	181/17	23/1	0.4538
Diameter of portal trunk (mm), mean ± SD (range)	11.9 ± 2.4 (4.9-22.7)	10.1 ± 2.0 (7.7-14.0)	0.0013
Collateral vessels (-/+)1	29/169	0/24	0.0443
Left gastric vein (hepatofugal)	137 (69.2)	9 (37.5)	0.0020
Short gastric vein (hepatofugal)	32 (16.2)	12 (50.0)	< 0.0001
Splenorenal shunt (hepatofugal)	16 (8.1)	6 (25.0)	0.0088
Paraumbilical vein (hepatofugal)	53 (26.8)	2 (8.3)	0.0482
Inferior mesenteric vein (hepatofugal)	9 (4.5)	4 (16.7)	0.0169
Characteristics of the largest collateral vessel
Diameter > 8.7 (mm)2	26 (13.1)	17 (70.8)	< 0.0001
Flow velocity > 10.2 (cm/s)2	87 (43.9)	17 (70.8)	0.0126
Flow volume > 310 (mL/min)2	52 (26.3)	16 (66.7)	< 0.0001

¹-: absence, +: presence;

²Cut-off value was determined using the receiver operating characteristics analysis.

Table 3 Clinical findings in the subjects

	Forward portal flow	Non-forward portal flow	P value
Number of subjects	198	24
Age (yr), mean ± SD (range)	61.9 ± 10.9 (35-89)	60.0 ± 12.6 (20-78)	0.4070
Sex (male/female)	110/88	10/14	0.1973
Etiology (Virus/Alcohol/NASH/PBC/AIH/others)	93/33/9/20/11/32	8/4/1/4/0/7	0.4003
Ascites (-/+/++)1	137/32/29	14/6/4	0.4949
Esophageal varices (-/+)2	73/125	10/14	0.6464
Gastric varices (-/+)2	155/43	13/11	0.0093
History of variceal bleeding (-/+)2	140/58	18/6	0.6610
History of variceal treatment (-/+)2	152/46	18/6	0.8469
Spleen (cm2), mean ± SD (range)	28.9 ± 12.9 (10.3-99.6)	29.0 ± 16.4 (10.5-90.5)	0.9900
Hepatic encephalopathy (-/+)3	190/8	23/1	0.9764
Child-Pugh (A/B/C)	92/84/22	6/9/9	0.0015
Decompensated cirrhosis (-/+)2	92/106	7/17	0.1074
Model for end-stage liver disease score4, mean ± SD (range)	11.0 ± 3.9 (6-24)	13.1 ± 4.8 (6-24)	0.0335
Blood test
Bilirubin (mg/dL), mean ± SD (range)	1.8 ± 2.0 (0.3-16.9)	3.2 ± 3.3 (0.6-13.4)	0.0578
Albumin (g/dL), mean ± SD (range)	3.4 ± 0.6 (1.5-4.7)	3.1 ± 0.5 (1.8-3.9)	0.0039
Prothrombin time (%), mean ± SD (range)	69.0 ± 17.9 (29-133)	62.5 ± 21.4 (19-106)	0.1026
Platelet count (× 104/μL), mean ± SD (range)	9.5 ± 5.9 (1.7-43.9)	10.8 ± 6.0 (2.5-23.3)	0.2976

¹Ascites -: none; +: mild; ++: moderate to severe:

²-: absence; +: presence;

³Hepatic encephalopathy -: grades 0-I; +: grades II-IV (West-Haven grading system);

⁴Forty-seven patients were excluded because prothrombin time-international normalized ratio was not measured in our hospital until 2004. AIH: Autoimmune hepatitis; NASH: Nonalcoholic steatohepatitis; PBC: Primary biliary cirrhosis.

Table 4 Cox regression analyses of the predictive factors for the development of non-forward portal flow

	Univariate hazard ratio (95%CI)	P value	Multivariate hazard ratio (95%CI)	P value
Diameter of portal trunk (< 11.2 mm)1	2.677 (1.269-5.648)	0.0097	-	-
Collateral vessels (flow velocity > 9.5 cm/s)1	2.818 (1.238-6.416)	0.0136	3.070 (1.276-7.389)	0.0123
Short gastric vein (hepatofugal)	3.039 (1.374-6.720)	0.0061	3.987 (1.736-9.158)	0.0011
Splenorenal shunt (hepatofugal)	3.485 (1.323-9.180)	0.0115	3.428 (1.143-10.278)	0.0279

¹Cut-off value was determined using the receiver operating characteristics analysis.