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Portal vein thrombosis in patients with cirrhosis: just a common finding or a predictor of poor outcome?
Omar D. Borjas-Almaguer*, Carlos A. Cortez-Hernández**, Emmanuel I. González-Moreno**,
Corresponding author
emmanuelgzz@meduanl.com

Correspondence and reprint request:
, Francisco J. Bosques-Padilla**, José A. González-González**, Aldo A. Garza**, Juan A. Martínez-Segura**, Diego García-Compean**, Juan V. Alejandre-Loya**, Jesús García-García**, Guillermo Delgado-García*, Héctor J. Maldonado-Garza**
* Internal Medicine Department, Universidad Autónoma de Nuevo León. Monterrey, México
** Gastroenterology Division. Hospital Universitario “Dr. José Eleuterio González”. Universidad Autónoma de Nuevo León. Monterrey, México. Madero y Gonzalitos S/N, Monterrey, Nuevo León, México. 64460 México
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="s0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0015">Introduction</span><p id="p0005" class="elsevierStylePara elsevierViewall">Liver cirrhosis is a global health problem with an estimated prevalence in the United States of 0&#46;27&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0005">1</a> In Mexico&#44; it is the fourth and second place in global mortality and mortality in productive age&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bib0010">2</a> Several predictors of mortality have been described in cirrhosis&#44; with the most reliable being the Child-Pugh and Model for End Stage Liver Disease &#40;MELD&#41; score&#46;<a class="elsevierStyleCrossRef" href="#bib0015">3</a> The coagulation system in patients with liver disease suffers several changes&#44; going to pro-thrombotic or predisposition to bleeding depending on the predominating factors&#46;<a class="elsevierStyleCrossRef" href="#bib0020">4</a> Nowadays&#44; there is a wide availability of imaging techniques used routinely in patients with cirrhosis to assess complications&#46; This has caused an increase in the diagnosis of portal vein thrombosis &#40;PVT&#41; not related to malignancy&#46; Portal vein thrombosis has been reported from 1 to 22&#37; in different studies&#46;<a class="elsevierStyleCrossRef" href="#bib0025">5</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0030">6</a> Increased gastrointestinal hemorrhage and intestinal infarction has been linked to PVT&#46;<a class="elsevierStyleCrossRef" href="#bib0035">7</a> However it is unclear whether non-malignancy related PVT is associated with reduced survival or if it is epiphenomenon of advanced liver disease&#46; Some studies have found similar survival rates and even lower mortality in patients with PVT&#46;<a class="elsevierStyleCrossRef" href="#bib0040">8</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0045">9</a> In Mexico the prevalence of PVT or the clinical outcome in these patients is unknown&#46; Therefore&#44; we decided to conduct this study assessing as the primary objective its relevance on clinical outcome&#58; such as upper gastrointestinal bleeding&#44; spontaneous bacterial peritonitis &#40;SBP&#41;&#44; grade 3 or 4 encephalopathy&#44; large volume ascites and overall survival and secondary outcome the prevalence of PVT not associated to malignancy&#46;</p></span><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0020">Material and Methods</span><p id="p0010" class="elsevierStylePara elsevierViewall">We conducted a retrospectively search from June 2011 to December 2014 of patients treated with the ICD 10 diagnosis of &#8220;fibrosis and liver cirrhosis&#8221; or &#8220;other cirrhosis&#8221; in a single center &#40;Hospital Universitario&#44; UANL&#41;&#46; Liver cirrhosis was diagnosed by physical examination&#44; laboratory exams&#44; radiologic study and&#47;or histopathology&#46; We excluded patients with known malignancy&#59; incomplete medical record or those patients who did not have at least one follow up at this institution&#46; Hepatocellular carcinoma and other primary malignancies were excluded with physical examination&#44; upper endoscopy&#44; and radiologic examination &#40;computed tomography&#41;&#46; In our patients&#44; no other cause of PVT was suspected&#46;</p><p id="p0015" class="elsevierStylePara elsevierViewall">For each patient we registered age&#44; gender&#44; etiology of cirrhosis&#44; CHILD and MELD score&#44; hemoglobin&#44; platelets&#44; albumin&#44; globulin&#44; aspartate aminotransferase &#40;AST&#41;&#44; alanine aminotransferase &#40;ALT&#41;&#44; alkaline phosphatase &#40;ALP&#41;&#44; total and indirect bilirubin&#44; glucose&#44; creatinine&#44; coagulation panel&#44; diagnosis of PVT and last follow up at the hospital&#46; The diagnosis of PVT was made by Doppler ultrasonography &#40;GE Logic 7&#44; 2007&#41; or contrast-enhanced tomography&#44; both interpreted by a radiologist&#46; Portal vein thrombosis was defined when there was endoluminal material with partial or total absence of flow or the presence of cavernous transformation&#46;</p><p id="p0020" class="elsevierStylePara elsevierViewall">Data were retrieved on an Excel spread &#40;Microsoft Office 2013&#41; and analyzed with SPSS software Version 20 for Windows &#40;IBM Corp&#46; 1989-2011&#41;&#46; Normality was studied using the Shapiro-Wilk test&#46; Categorical variables were presented as percentages and frequencies and continuous variables as means and standard deviations or medians and minimum and maximum range&#46; Student&#8217;s <span class="elsevierStyleItalic">t</span> test and the Mann-Whitney <span class="elsevierStyleItalic">U</span> test were used to compare continuous variables according to normality&#46; Categorical variables were compared with &#967;<a class="elsevierStyleCrossRef" href="#bib0010">2</a>&#46; Kaplan-Meier was used to assess survival and frequency of clinical outcomes&#46; A two tailed-P value &#60; 0&#46;05 was considered statistically significant&#46;</p></span><span id="s0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0025">Results</span><span id="s0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0030">General characteristics</span><p id="p0025" class="elsevierStylePara elsevierViewall">We identified 189 patients&#44; however&#44; we excluded 15 patients with a diagnosis of malignancy and 5 with an incomplete medical record&#46; Therefore&#44; we included 169 patients&#46; Fifty-five women and 114 men&#44; median age was 54 &#40;19-90&#41; years&#46; Thirteen patients &#40;7&#46;6&#37;&#41; presented PVT&#44; 8 had a diagnosis made by ultrasonography and contrast enhanced tomography and 5 only with ultrasonography&#46; Nine patients had total thrombosis&#44; 3 had partial thrombosis and 1 had cavernous degeneration&#46; None of the patients with PVT received anticoagulation treatment&#46; The analysis was divided in two groups&#44; patients with PVT and patients without PVT&#46; The patients with PVT were younger &#40;49 <span class="elsevierStyleItalic">vs&#46;</span> 55 years p &#61; 0&#46;025&#41;&#44; and male gender was predominant in both groups &#40;8 &#91;61&#46;5&#37;&#93; and 106 &#91;67&#46;9&#37;&#93;&#44; respectively&#41; without being statistically significant &#40;<a class="elsevierStyleCrossRef" href="#t0005">Table 1</a>&#41;&#46; The predominant etiology of cirrhosis was alcohol in both groups &#40;<a class="elsevierStyleCrossRef" href="#t0010">Table 2</a>&#41;&#46; Child A was more frequent in the PVT group &#40;4 &#91;30&#46;8&#37;&#93; <span class="elsevierStyleItalic">vs&#46;</span> 8 &#91;5&#46;1&#37;&#93;&#41;&#44; and Child C in the non-PVT group &#40;6 &#91;46&#46;2&#37;&#93; <span class="elsevierStyleItalic">vs&#46;</span> 89 &#91;57&#46;1&#37;&#93;&#41;&#46; MELD score mean was lower among PVT patients &#40;12 &#91;8-21&#93; <span class="elsevierStyleItalic">vs&#46;</span> 19 &#91;7-51&#93; p&#61; &#60;0&#46;001&#41;&#46; Prothrombin time&#44; INR and total bilirubin also were lower in PVT patients&#46; Finally&#44; platelet levels were higher in PVT patients &#40;183&#44;000 &#91;60&#44;000-332&#44;000&#93; <span class="elsevierStyleItalic">vs&#46;</span> 106 &#91;3&#44;000-508&#44;000&#93; p&#61; 0&#46;003&#41;&#46;</p><elsevierMultimedia ident="t0005"></elsevierMultimedia><elsevierMultimedia ident="t0010"></elsevierMultimedia></span><span id="s0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0035">Clinical outcome</span><p id="p0030" class="elsevierStylePara elsevierViewall">We performed Kaplan-Meier analysis for upper gastrointestinal bleeding&#44; spontaneous bacterial peritonitis&#44; encephalopathy&#44; large volume ascites and global survival&#46; The frequency of upper gastrointestinal bleeding &#40;8 &#91;61&#46;5&#37;&#93; <span class="elsevierStyleItalic">vs&#46;</span> 78 &#91;50&#37;&#93;&#41; and spontaneous bacterial peritonitis &#40;2 &#91;15&#46;4&#37;&#93; <span class="elsevierStyleItalic">vs&#46;</span> 39 &#91;25&#37;&#93;&#41; was not statistically different between groups &#40;p &#61; 0&#46;84 and p &#61; 0&#46;67 respectively&#41;&#46; However&#44; the rate of encephalopathy &#40;grade 3-4&#41; requiring inhospital treatment was better in the PVT group &#40;4 &#91;30&#46;8&#37;&#93; <span class="elsevierStyleItalic">vs&#46;</span> 73 &#91;46&#46;8&#37;&#93; p&#61; 0&#46;007&#41;&#46; Large volume ascites was also less frequent in the PVT group &#40;5 &#91;38&#46;5&#37;&#93; <span class="elsevierStyleItalic">vs&#46;</span> 89 &#91;57&#46;1&#37;&#93; p&#61; 0&#46;012&#41; &#40;<a class="elsevierStyleCrossRef" href="#t0015">Table 3</a>&#41;&#46; One patient &#40;8&#37;&#41; in PVT and 56 &#40;36&#37;&#41;&#41; in non-PVT died during follow up &#40;p &#61; 0&#46;063&#41;&#46; Global survival was better for patients with PVT &#40;16&#46;5 &#177; 27&#46;9 <span class="elsevierStyleItalic">vs&#46;</span> 4&#46;13 &#177; 12&#46;2 months p &#61; 0&#46;005&#41; &#40;<a class="elsevierStyleCrossRef" href="#f0005">Figure 1</a>&#41;&#46;</p><elsevierMultimedia ident="t0015"></elsevierMultimedia><elsevierMultimedia ident="f0005"></elsevierMultimedia></span></span><span id="s0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0040">Discussion</span><p id="p0035" class="elsevierStylePara elsevierViewall">Acute decompensating precipitants that lead to organ failure in patients with cirrhosis have a mortality of 30&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0050">10</a> Importantly&#44; mortality is higher in previously compensated patients than in those with previous decompensation&#46; Precipitating factors such as infections&#44; PVT&#44; surgery&#44; and hepatocellular carcinoma generally trigger decompensating events&#46;<a class="elsevierStyleCrossRef" href="#bib0055">11</a> Several factors can lead to the development of PVT in patients with cirrhosis&#44; primarily from a reduction in portal blood flow and hypercoagulability&#46;<a class="elsevierStyleCrossRef" href="#bib0060">12</a></p><p id="p0040" class="elsevierStylePara elsevierViewall">The aim of this study was to assess the relevance on clinical outcome in cirrhotic patients with PVT not associated with malignancy and its prevalence&#46; In Mexico&#44; to our knowledge&#44; there are no studies assessing this outcome&#46; The prevalence in our study was 7&#46;6&#37;&#44; similar to the range previously reported in the literature&#46;<a class="elsevierStyleCrossRef" href="#bib0025">5</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0065">13</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0070">14</a> Contrary to previous studies&#44;<a class="elsevierStyleCrossRefs" href="#bib0075">15</a>&#8211;<a class="elsevierStyleCrossRef" href="#bib0085">17</a> we found that patients with PVT are younger&#46;</p><p id="p0045" class="elsevierStylePara elsevierViewall">Male gender and alcohol etiology were predominant&#44; similar to what has been previously found in our country&#46;<a class="elsevierStyleCrossRef" href="#bib0090">18</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0095">19</a> This is due to the trends of alcohol consumption in Mexico&#46;<a class="elsevierStyleCrossRef" href="#bib0095">19</a> We found more patients being classified as cryptogenic cirrhosis compared to the literature&#44;<a class="elsevierStyleCrossRef" href="#bib0045">9</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0080">16</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0100">20</a> but in our country&#44; most of the patients are evaluated without specialized studies due to economic burden&#44; therefore there could be less patients with this diagnosis&#46; The patients in the PVT group had lower Child-Pug and MELD score compared with the patients in non-PVT&#46; This could be explained in part because patients with non-PVT are more likely to visit a hospital due to symptomatology caused by cirrhosis complications following poor hepatic reserve&#46; However&#44; we did not explore the presence of abdominal pain because of the retrospective design&#46; Nonetheless&#44; the MELD score in the patients in our group without PVT was significantly higher compared to previous studies&#46;<a class="elsevierStyleCrossRef" href="#bib0045">9</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0075">15</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0100">20</a> PT&#44; INR and total bilirubin were lower in the PVT group while the platelet was count higher&#44; this could be due to the state of advanced disease in patients without PVT&#46;</p><p id="p0050" class="elsevierStylePara elsevierViewall">Upper gastrointestinal bleeding &#40;UGB&#41; did not differ between groups&#44; even though it has been described as a common presentation among patients with PVT&#59;<a class="elsevierStyleCrossRef" href="#bib0035">7</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0105">21</a> thus&#44; we do not consider PVT a risk factor for UGB as previously reported&#46;<a class="elsevierStyleCrossRef" href="#bib0035">7</a> The frequency of spontaneous bacterial peritonitis was the same&#44; and to date&#44; there is only a case report describing this finding in patients with PVT&#46;<a class="elsevierStyleCrossRef" href="#bib0110">22</a> Encephalopathy requiring in-hospital treatment was more frequent in patients without PVT contrasting previous studies&#46;<a class="elsevierStyleCrossRef" href="#bib0045">9</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0085">17</a> This could be explained due to the disparity of MELD score in both groups&#46; In our study&#44; we did not assess recanalization after diagnosis of PVT&#59; these patients have been described to achieve less frequently hepatic encephalopathy&#46;<a class="elsevierStyleCrossRef" href="#bib0115">23</a> Nonetheless&#44; it has been proposed that patients with PVT develop high levels of ammonia due to porto-systemic shunts leading to sub-clinical neurological abnormalities compatible with minimal hepatic encephalopathy&#46;<a class="elsevierStyleCrossRef" href="#bib0120">24</a> Contrary to our findings&#44; these patients do not seem to be at more risk for presenting hepatic encephalopathy&#46; Large volume ascites was also more frequent in non-PVT patients&#46; Moderate ascites has been described previously in patients with PVT&#59;<a class="elsevierStyleCrossRef" href="#bib0045">9</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0075">15</a> however&#44; we believe this finding could be the result of advanced liver stage in the non-PVT group&#46; Global mortality was less for patients with PVT&#44; a finding consistent with previous reports&#46;<a class="elsevierStyleCrossRef" href="#bib0045">9</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0075">15</a></p><p id="p0055" class="elsevierStylePara elsevierViewall">Recently&#44; Hugenholtz&#44; <span class="elsevierStyleItalic">et al&#46;</span> remarked the importance of anticoagulation in patients with cirrhosis in different settings including PVT&#59;<a class="elsevierStyleCrossRef" href="#bib0125">25</a> however&#44; we found that PVT by itself does not carry a worse prognosis in terms of survival&#44; UGB&#44; SBP&#44; large volume ascites or encephalopathy&#44; even if it does not receive anticoagulation treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0040">8</a> The reliable variable to predict outcomes remains the MELD score&#46; Most of our patients had MELD scores above 14 and all of our findings could be explained by diminished hepatic function&#46; The presence of PVT could be just an epiphenomenon and not a marker of advanced liver disease&#46;</p><p id="p0060" class="elsevierStylePara elsevierViewall">To our knowledge&#44; this is the first study to report the prevalence of PVT in Mexico&#44; and confirms many findings described previously about PVT&#46; However&#44; our study also has some limitations&#46; It is a single center retrospective study&#44; we did not assess recanalization of PVT and we did not have the information of mutations that predispose to thrombosis&#46;<a class="elsevierStyleCrossRef" href="#bib0020">4</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0085">17</a> This study opens the scenario to calculate the size for prospective studies and randomized clinical trials to evaluate the benefits and harms of anticoagulation treatment&#46;</p></span><span id="s0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0045">Abbreviations</span><p id="p0065" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="l0005"><li class="elsevierStyleListItem" id="u0005"><span class="elsevierStyleLabel">&#8226;</span><p id="p0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">ALP&#58;</span> alkaline phosphatase&#46;</p></li><li class="elsevierStyleListItem" id="u0010"><span class="elsevierStyleLabel">&#8226;</span><p id="p0075" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">ALT&#58;</span> alanine aminotransferase&#46;</p></li><li class="elsevierStyleListItem" id="u0015"><span class="elsevierStyleLabel">&#8226;</span><p id="p0080" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">AST&#58;</span> aspartate aminotransferase&#46;</p></li><li class="elsevierStyleListItem" id="u0020"><span class="elsevierStyleLabel">&#8226;</span><p id="p0085" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">MEDL&#58;</span> Model for End Stage Liver Disease&#46;</p></li><li class="elsevierStyleListItem" id="u0025"><span class="elsevierStyleLabel">&#8226;</span><p id="p0090" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">PVT&#58;</span> portal vein thrombosis&#46;</p></li><li class="elsevierStyleListItem" id="u0030"><span class="elsevierStyleLabel">&#8226;</span><p id="p0095" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">UGB&#58;</span> upper gastrointestinal bleeding&#46;</p></li></ul></p></span><span id="s0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0050">Conflict of Interest</span><p id="p0100" class="elsevierStylePara elsevierViewall">None&#46;</p></span><span id="s0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0055">Financial Support</span><p id="p0105" class="elsevierStylePara elsevierViewall">None&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
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        0 => array:3 [
          "identificador" => "xres1207321"
          "titulo" => "Abstract"
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              "identificador" => "abs0010"
            ]
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        1 => array:2 [
          "identificador" => "xpalclavsec1124367"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "s0005"
          "titulo" => "Introduction"
        ]
        3 => array:2 [
          "identificador" => "s0010"
          "titulo" => "Material and Methods"
        ]
        4 => array:3 [
          "identificador" => "s0015"
          "titulo" => "Results"
          "secciones" => array:2 [
            0 => array:2 [
              "identificador" => "s0020"
              "titulo" => "General characteristics"
            ]
            1 => array:2 [
              "identificador" => "s0025"
              "titulo" => "Clinical outcome"
            ]
          ]
        ]
        5 => array:2 [
          "identificador" => "s0030"
          "titulo" => "Discussion"
        ]
        6 => array:2 [
          "identificador" => "s0035"
          "titulo" => "Abbreviations"
        ]
        7 => array:2 [
          "identificador" => "s0040"
          "titulo" => "Conflict of Interest"
        ]
        8 => array:2 [
          "identificador" => "s0045"
          "titulo" => "Financial Support"
        ]
        9 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2016-01-18"
    "fechaAceptado" => "2016-05-03"
    "PalabrasClave" => array:1 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1124367"
          "palabras" => array:5 [
            0 => "Cirrhosis"
            1 => "Portal vein thrombosis"
            2 => "Prognosis"
            3 => "MELD Score"
            4 => "Child-Pugh Score"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:1 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abs0010" class="elsevierStyleSection elsevierViewall"><p id="sp0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Background &#38; Aims&#46;</span> It is unclear whether portal vein thrombosis &#40;PVT&#41; unrelated to malignancy is associated with reduced survival or it is an epiphenomenon of advanced cirrhosis&#46; The objective of this study was to assess clinical outcome in cirrhotic patients with PVT not associated with malignancy and determine its prevalence&#46;</p><p id="sp1075" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Material and methods&#46;</span> Retrospective search in one center from June 2011 to December 2014&#46;</p><p id="sp1030" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Results&#46;</span> 169 patients&#44; 55 women and 114 men&#44; median age 54 &#40;19-90&#41; years&#46; Thirteen had PVT &#40;7&#46;6&#37;&#41;&#46; None of the patients received anticoagulant treatment&#46; The PVT group was younger &#40;49 &#91;25-62&#93; vs&#46; 55 &#91;19-90&#93; years p &#61; 0&#46;025&#41;&#46; Child A patients were more frequent in PVT and Child C in Non-PVT&#46; Median Model for End Stage Liver Disease &#40;MELD&#41; score was lower in PVT &#40;12 &#91;8-21&#93; <span class="elsevierStyleItalic">vs&#46;</span> 19 &#91;7-51&#93; p &#8804; 0&#46;001&#41; p &#8804; 0&#46;001&#41;&#46; There was no difference between upper gastrointestinal bleeding and spontaneous bacterial peritonitis in the groups&#46; Encephalopathy grade 3-4 &#40;4 &#91;30&#46;8&#37;&#93; <span class="elsevierStyleItalic">vs&#46;</span> 73 &#91;46&#46;8&#37;&#93; p &#61; 0&#44;007&#41; and large volume ascites &#40;5 &#91;38&#46;5&#37;&#93; <span class="elsevierStyleItalic">vs&#46;</span> 89 &#91;57&#46;1&#37;&#93; p&#61; 0&#44;012&#41; was more common in non-PVT&#46; Survival was better for PVT &#40;16&#46;5 &#177; 27&#46;9 <span class="elsevierStyleItalic">vs&#46;</span> 4&#46;13 &#177; 12&#46;2 months p &#61; 0&#46;005&#41;&#46; Conclusions&#58; We found that PVT itself does not lead to a worse prognosis&#46; The most reliable predictor for clinical outcome remains the MELD score&#46; The presence of PVT could be just an epiphenomenon and not a marker of advanced cirrhosis&#46;</p></span>"
      ]
    ]
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        "tipo" => "MULTIMEDIAFIGURA"
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          "en" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Survival in months&#46;</p>"
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        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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        "tabla" => array:2 [
          "leyenda" => "<p id="np0005" class="elsevierStyleSimplePara elsevierViewall">&#42; <span class="elsevierStyleItalic">F&#58; female&#46; M&#58; male&#44; MELD&#58; Model for End Stage Liver Disease&#46; Hb&#58; hemoglobin&#46; PLT&#58; platelets&#46; Alb&#58; albumin&#46; TB&#58; total bilirubin&#46; IB&#58; Indirect bilirubin&#46; Glu&#58; glucose&#46; Crea&#58; creatinine&#46; PT&#58; prothrombin time&#46; PTT&#58; partial thromboplastin time&#46; INR&#58; international normalized ratio&#46;</span></p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PVT thrombosis &#40;n &#61; 13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Non-PVT &#40;n &#61; 156&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49 &#40;25-62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55 &#40;19-90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;025</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="top">Gender &#40;number and percentage&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&#58; 5 &#40;38&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&#58; 50 &#40;32&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;759&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#58; 8 &#40;61&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#58; 106 &#40;67&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="top">Child-Pugh &#40;number and percentage&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&#58; 4 &#40;30&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&#58; 8 &#40;5&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;002</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B&#58; 3 &#40;23&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B&#58; 56 &#40;37&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">PT Sec&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">PTT Sec&nbsp;\t\t\t\t\t\t\n
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                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2060809.png"
              ]
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Demographic characteristics&#46;</p>"
        ]
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      2 => array:7 [
        "identificador" => "t0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
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          "tablatextoimagen" => array:1 [
            0 => array:2 [
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                0 => """
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Etioiogy&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Global &#40;n &#61; 169&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PVT &#40;n &#61; 13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Non-PVT &#40;n &#61; 156&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alcohol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98 &#40;58&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;46&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92 &#40;59&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Viral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;5&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;7&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;5&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Autoimmune&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;6&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;23&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;5&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Drug&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;2&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;2&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cryptogenic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34 &#40;20&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;15&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;20&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NASH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;3&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;7&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;3&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Biliary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;3&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;3&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">Etioloqv of cirrhosis&#46;</p>"
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          "leyenda" => "<p id="np0010" class="elsevierStyleSimplePara elsevierViewall">&#42; <span class="elsevierStyleItalic">Some patients hhadd 2 or more complications&#46;</span></p>"
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PVT &#40;n &#61; 13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Non-PVT &#40;n &#61; 156&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UGB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;61&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;084&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SBP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;15&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;067&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Encephalopathy &#40;grade 3-4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;30&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73 &#40;46&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;007</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Large volume ascites&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;38&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89 &#40;57&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;012</span>&nbsp;\t\t\t\t\t\t\n
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            0 => array:3 [
              "identificador" => "bib0005"
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The Epidemiology of Cirrhosis in the United States&#58; A Population-based Study"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Scaglione S&#46;"
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                            2 => "Cao G&#46;"
                            3 => "Shoham D&#46;"
                            4 => "Durazo R&#46;"
                            5 => "Luke A&#46;"
                            6 => "Volk M&#46;L&#46;"
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                    0 => array:2 [
                      "doi" => "10.1097/MCG.0000000000000208"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Gastroenterol"
                        "fecha" => "2015"
                        "volumen" => "49"
                        "paginaInicial" => "690"
                        "paginaFinal" => "696"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25291348"
                            "web" => "Medline"
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            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2&#46;"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "SINAS&#46; Mortalidad&#46; Informaci&#243;n tabular&#46; Available from&#58; http&#58;&#47;&#47;sinais&#46;salud&#46;gob&#46;mx&#47;mortalidad&#47;&#58; 2008&#59; 2008 &#91;updated 2011&#59; cited 2015 03&#47;05&#47;2015&#93;&#46;"
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            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Liver cirrhosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Schuppan D&#46;"
                            1 => "Afdhal N&#46;H&#46;"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(08)60383-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2008"
                        "volumen" => "371"
                        "paginaInicial" => "838"
                        "paginaFinal" => "851"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18328931"
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              "identificador" => "bib0020"
              "etiqueta" => "4&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The coagulation system in patients with end-stage liver disease"
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                          "etal" => false
                          "autores" => array:2 [
                            0 => "Valla D&#46;C&#46;"
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                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/liv.12723"
                      "Revista" => array:7 [
                        "tituloSerie" => "Liver Int"
                        "fecha" => "2015"
                        "volumen" => "35"
                        "numero" => "Suppl&#46; 1"
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                        "paginaFinal" => "144"
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              "etiqueta" => "5&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The incidence of portal vein thrombosis at liver transplantation"
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                          "etal" => false
                          "autores" => array:4 [
                            0 => "Nonami T&#46;"
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                            2 => "Iwatsuki S&#46;"
                            3 => "Starzl T&#46;E&#46;"
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                  "host" => array:1 [
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Article information
ISSN: 16652681
Original language: English
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es en pt

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