S2818 Bowel Ischemia in Non-Cirrhotic Portal Vein Thrombosis: A Nationwide Analysis of Predictors and Outcomes

Introduction: Bowel ischemia is a severe but understudied complication of portal vein thrombosis, particularly in non-cirrhotic patients. While traditional thrombotic risk factors such as malignancy, inflammatory bowel disease, and hypercoagulability are presumed to increase risk, this assumption lacks population-level validation. This study aimed to identify clinical predictors of bowel ischemia and assess its impact on outcomes in non-cirrhotic PVT hospitalizations using a nationally representative dataset. Methods: We conducted a cross-sectional analysis of the 2018–2021 National Inpatient Sample to identify hospitalizations for non-cirrhotic PVT using International Classification of Diseases, Tenth Revision (ICD-10) codes. Patients with cirrhosis or chronic liver disease were excluded. Bowel ischemia was defined via validated ICD-10 codes. Multivariable logistic regression adjusted for demographics, clinical factors, and socioeconomic variables, including age, sex, sepsis, malignancy, IBD, hypercoagulable states, pancreatitis, and MPNs. Secondary outcomes were ICU care, mortality, LOS and hospitalization costs. Results: Among 25,863 hospitalizations for non-cirrhotic PVT, bowel ischemia occurred in 2.3%. Sepsis was the strongest independent predictor (aOR 2.11; 95% CI: 1.75–2.55; P < 0.001), followed by older age (aOR 1.007 per year; 95% CI: 1.001–1.014; P = 0.026) and female sex (aOR 1.21; 95% CI: 1.03–1.43; P = 0.02). In contrast, malignancy (aOR 0.44; 95% CI: 0.36–0.54) and pancreatitis (aOR 0.40; 95% CI: 0.29–0.55) were associated with significantly lower odds of ischemia (P < 0.001). IBD, MPNs, and hypercoagulable states were not significantly associated. Bowel ischemia independently predicted ICU care (aOR 2.22; 95% CI: 1.65–2.98), in-hospital mortality (aOR 2.23; 95% CI: 1.77–2.80), prolonged LOS (+2.63 days; P < 0.001), and increased hospitalization charges (+$82,442; 95% CI: $50,878–$114,006; P < 0.001). Conclusion: Bowel ischemia in non-cirrhotic PVT is uncommon but associated with significantly worse outcomes, including a twofold increase in ICU admission and in-hospital mortality. Sepsis and age were consistent independent predictors. Surprisingly, malignancy and pancreatitis were inversely associated with ischemia, suggesting potential influences from differential coding, treatment pathways, or protective care factors. Traditional thrombotic risk profiles may not adequately capture ischemic risk in this population. These findings highlight the need for improved risk stratification and earlier recognition strategies to guide clinical decision-making.