S2507 Effect of Thromboembolic Events on Long-Term Treatment Outcomes in Liver Cirrhosis

Introduction: Liver cirrhosis can be associated with a hypercoagulable state, which in turn can result in deep venous thrombosis (DVT), pulmonary embolism (PE) or portal vein thrombosis (PVT). These conditions alter circulatory hemodynamics and thus the disease course. They also present a treatment dilemma due to the cirrhosis-related risk of variceal hemorrhage. No national study to date has examined the long-term outcome of this patient population. Methods: All patients admitted with liver cirrhosis in the United States in January were identified from 2016 to 2022 through the National Readmission Database. Patients with a principal diagnosis of either DVT/PE or PVT were identified. The follow-up period was 12 months. The primary outcome was liver decompensation. The secondary outcomes were 1-year mortality, incidence of esophageal or gastric varices, variceal hemorrhage, ascites, hepatic encephalopathy, acute liver failure and liver transplantation. Diagnoses were identified using International Classification of Diseases, Tenth Revision (ICD-10) CM codes. Logistic regression models were used to adjust for confounders, which were age, sex, income in the patient’s zipcode, insurance type, Charlson score and hospital bedsize, teaching status and urban location. Results: Overall, 365,848 patients were included in the study. Of those, 1,767 patients had a DVT/PE and 695 had PVT. The mean age was 61 years. The majority of patients were men, of lower income, insured by Medicare or Medicaid, and treated at large urban non-teaching hospitals. Compared with patients without thromboembolism, patients with DVT/PE had lower adjusted odds of all-cause mortality, new ascites development and incident liver decompensation. On the other hand, PVT was associated with almost 3-fold increase in the adjusted odds of both new gastric or esophageal varices and variceal hemorrhage as well as 50% increase in the adjusted odds of acute liver failure. The 3 patient groups had similar adjusted odds of liver transplantation and incident hepatic encephalopathy. Conclusion: The development of DVT/PE is not associated with worsening outcomes among patients with liver cirrhosis and seems to be protective against liver decompensation and 1-year mortality. On the other hand, portal vein thrombosis is associated with a substantial increase in the risk of varices, variceal hemorrhage and acute liver failure. These finding can help guide follow-up frequency and prognosis discussion in this setting.