Published online Nov 28, 2015. doi: 10.4254/wjh.v7.i27.2774
Peer-review started: September 19, 2015
First decision: October 21, 2015
Revised: November 2, 2015
Accepted: November 10, 2015
Article in press: November 11, 2015
Published online: November 28, 2015
AIM: To determine the clinical impact of portal vein thrombosis in terms of both mortality and hepatic decompensations (variceal hemorrhage, ascites, portosystemic encephalopathy) in adult patients with cirrhosis.
METHODS: We identified original articles reported through February 2015 in MEDLINE, Scopus, Science Citation Index, AMED, the Cochrane Library, and relevant examples available in the grey literature. Two independent reviewers screened all citations for inclusion criteria and extracted summary data. Random effects odds ratios were calculated to obtain aggregate estimates of effect size across included studies, with 95%CI.
RESULTS: A total of 226 citations were identified and reviewed, and 3 studies with 2436 participants were included in the meta-analysis of summary effect. Patients with portal vein thrombosis had an increased risk of mortality (OR = 1.62, 95%CI: 1.11-2.36, P = 0.01). Portal vein thrombosis was associated with an increased risk of ascites (OR = 2.52, 95%CI: 1.63-3.89, P < 0.001). There was insufficient data available to determine the pooled effect on other markers of decompensation including gastroesophageal variceal bleeding or hepatic encephalopathy.
CONCLUSION: Portal vein thrombosis appears to increase mortality and ascites, however, the relatively small number of included studies limits more generalizable conclusions. More trials with a direct comparison group are needed.
Core tip: Portal vein thrombosis (PVT) is a common complication of cirrhosis with resultant downstream hepatic decompensation and mortality. Treatment options carry risk and are not without complications. To date, there is a lack of systematic evidence on the clinical importance of PVT. We performed a systematic review and meta-analysis to determine the aggregate estimates of effect of PVT on hepatic decompensation and mortality. PVT appears to significantly increase mortality (OR = 1.62, 95%CI: 1.11-2.36) and ascites (OR = 2.52, 95%CI: 1.63-3.89), however, the small number of included studies limits more generalizable conclusions. More trials with a direct comparison group are needed.