PORTA VEIN THROMBOSIS (PVT) IN CIRRHOTIC PATIENTS PRE AND DURING THE PANDEMIC BY SARS-COV2

Introduction

Determining the incidence and prevalence of PVT is difficult due to the heterogeneity of risk factors. The prevalence in cirrhotics is 1% in compensated patients and 8-25% in decompensated patients. SARS-COV2 infection presents extrapulmonary manifestations such as coagulation disorders with thrombotic angiopathy in 20-43%. In histopathological reports of necropsies or liver biopsies of patients who died from SARS-COV2, 30% had hepatic vascular thrombosis without chronic liver disease. IAM: To determine the prevalence of PVT in patients admitted to Gastroenterology before and during the SARS-COV2 pandemic.

Material and Methods

Research design: Descriptive, cross-sectional/prevalence. Procedure: We review medical records of all cirrhotic patients from March 2019 to February 2020 and from March 2020 to February 2021. We include cirrhotic patients diagnosed with PVT. Qualitative variables were expressed as frequencies and percentages. The numerical variables were expressed as means and standard deviations.

Results

In the pre-pandemic period: 491 cirrhotics admitted from March 2019 to February 2020 were identified, finding 24 cirrhotics with PVT (4.89%) 15(62.5%) were women with a mean age of 58.13 13.51 years. 6(25.0%) with neoplasms, of the latter 6(100.0%) with hepatocellular carcinoma. Regarding Child-Pugh: 11(45.8%) were B and 13(54.2%) were C and a mean MELD of 21.58. Regarding the location of the thrombus: 14(58.3%) occurred in the portal trunk, 6 (25.0%) in the trunk and branches, and 4(16.7%) only in one branch. During the pandemic period, we identified 189 cirrhotic patients; 24(12.60%) were cirrhotic with PVT. Of the latter, 12(50%) were men, with a mean age of 60.6311.93, 3(12.5%) had neoplasia and of these, 2(8.3%) were hepatocellular carcinoma. According to the Child-Pugh: 1(4.2%) was A, 12(50%) was B and 11(45.8%) was C with a mean MELD of 23.08, 15(62.5%) had acute kidney injury, 4(16%) had atypical pneumonia upon admission, 16(66.7%) had ascites, of these 10(41.7%) were grade II. According to laboratory tests: creatinine 6.48±19.53, uric acid 9.22±3.58, albumin 2.53±0.55, INR 1.81±1.07, and DHL 217.37±83.77. 95.8% underwent USG and 41.7% angiotomography. Regarding the thrombosis characteristics, 50% were acute, 29.2% had cavernomatosis, 66.7% were located in the portal trunk, and 54.2% had total occlusion. Regarding treatment, only 5(20.8%) received enoxaparin.

Discussion

Patients with COVID-19 experience a state of hypercoagulability, either in the arterial and/or venous system. Currently, only one case report has described a patient with suspected COVID-19, but without RT-PCR confirmation for SARS-COV2 and who developed PVT during hospitalization. On the other hand, patients with advanced liver disease are at higher risk of developing PVT. In the present study, there is no confirmatory evidence of infection by SARS-COV2. Still, there is evidence of an increase in the number of PVT cases three times more during the pandemic, so it is inferred that PVT could be associated with the presence of this infection.

Conclusions

We found that during the pandemic an increase in PVT was evidenced in patients with less advanced liver disease and fewer comorbidities, but with a more severe clinical picture, so it is suggested to investigate the presence SARS-COV2 in patients with liver decompensation and suspected of the PVT.

The authors declare that there is no conflict of interest.