Portal vein thrombosis increases short-term mortality among hospitalized patients with cirrhosis in a global cohort

Background: Portal vein thrombosis (PVT) in cirrhosis is associated with adverse outcomes, but determinants of PVT and its impact on short-term outcomes in hospitalized patients across global regions remain unclear. Methods: The multinational CLEARED consortium prospectively enrolled adults with cirrhosis admitted non-electively after consent. Patients were followed during hospitalization and 30 days post-discharge. Radiologically diagnosed PVT was analyzed in relation to demography, etiology, clinical features, hospital course, and 30-day outcomes, including mortality. Results: Among 7,721 patients, etiologies included alcohol related (41.3%), MASH/cryptogenic (24.4%), hepatitis B (19.4%), and hepatitis C (11.3%). PVT was present in 773 patients (10.0%). Prevalence was higher in MASH/cryptogenic and viral cirrhosis compared with alcohol etiology (11.9%, 11.7% vs. 7.3%). Alcohol etiology was associated with lower odds of PVT [OR 0.64 (95% CI 0.5–0.8), p <0.001]. PVT was more common in patients with diabetes (37.4% vs. 28.9%) and in high-income countries (all p <0.001). Independent predictors of PVT included MASH/cryptogenic etiology [OR 1.59 (95% CI 1.2–2.1), p <0.01], prior portal hypertension–related complications (ascites, variceal bleeding, overt HE, hydrothorax), and non-selective beta-blocker use. PVT associated with higher rates of AKI, grade 3–4 hepatic encephalopathy, 30-day readmission, and liver transplantation (all p <0.05). Thirty-day mortality was higher in patients (22.1% vs. 18.0%; p =0.001), and PVT independently predicted mortality (OR 1.5; 95% CI 1.1–1.9; p <0.001). Conclusions: PVT affects one in ten patients in a global inpatient cirrhosis cohort, and independently predicts short-term mortality and major complications, identifying a high-risk subgroup requiring intensified inpatient and post-discharge care.

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Journal
Liver Transplantation
Published
2026-09-21
DOI
https://doi.org/10.1097/lvt.0000000000000994
Primary Topic
Liver Disease and Transplantation
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article
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article

Portal vein thrombosis increases short-term mortality among hospitalized patients with cirrhosis in a global cohort

Robert Livingstone, Patrick S. Kamath, Scott W. Biggins, Katina Zheng et al.
Liver Transplantation
Liver Disease and Transplantation
article

Portal vein thrombosis increases short-term mortality among hospitalized patients with cirrhosis in a global cohort

Robert Livingstone, Patrick S. Kamath, Scott W. Biggins, Katina Zheng, Shiv Kumar Sarin, Dinc Dinçer, Helena Katchman, Ramazan Idılman, Yashwi Haresh Kumar Patwa, Alaa Mostafa, Henok Fisseha, Amany Zekry, Liou Wei Lun, Paula Guedes, Neil Rajoriya, Xiangmei Wang, Lilian Torres Made, Suresh Vasan Venkatachalapathy, Gerry MacQuillan, Harendran Elangovan, Marie Jeanne Lohoues, Zeki Karasu, Aldo Torre, Kessarin Thanapirom, Büşra Haktanıyan, Sarai Gonzalez Hueso, Hibat Allah Belimi, Wei Wang, Peter Hayes, Shiva Kumar, Adrian Gadano, Nabiha Faisal, Hasan Basri Yapıcı, Mohammad Rela, Ajay Jhaveri, Mingqin Lu, Stephen Riordan, Ningping Zhang, Cailian Cai, Mark Topazian, Paul Thuluvath, Patricia Zitelli, Hak-Keith Leung, Hugo Vargas, Andrew Keaveny, Babatunde Duduyemi, Dibyalochan Praharaj, Amey Sonavane, Yu Jun Wong, Richard Goodheart, Francisco Felix-Tellez, Ewan Forrest, Wai Kay Seto, Kaleb A. Berhane, Huan Deng, Qinglang Xu, Zhiliang Gao, Ajay Duseja, Anil Arora, Ashish Goel, Shalimar, Feng Guo, Punita Tandon, Xin Zheng, Tao Li, Scott Silvey, Hong Tang, K Rajender Reddy, Brian J. Bush, Surender Kumar, Florence Wong, Ashok Choudhury, Anand V. Kulkarni, Mário Reis Álvares-da-Silva, Jacob George, Feng Peng, José Luis Pérez Hérnandez, Ahmed Hakem, Jasmohan S. Bajaj, Bin Xu, Jacqueline Cordova-Gallardo, Luis Garrido Trevino, Hai Li, Yongchao Xian, Chenghai Liu, Yue Wang, Robert Gibson, Elizabeth Verna, Arun Valsan, Michael Schultheiß, Ewan Marwan, Qing Xie, Cameron Gofton, Xinrui Wang
article en

Abstract

Background: Portal vein thrombosis (PVT) in cirrhosis is associated with adverse outcomes, but determinants of PVT and its impact on short-term outcomes in hospitalized patients across global regions remain unclear. Methods: The multinational CLEARED consortium prospectively enrolled adults with cirrhosis admitted non-electively after consent. Patients were followed during hospitalization and 30 days post-discharge. Radiologically diagnosed PVT was analyzed in relation to demography, etiology, clinical features, hospital course, and 30-day outcomes, including mortality. Results: Among 7,721 patients, etiologies included alcohol related (41.3%), MASH/cryptogenic (24.4%), hepatitis B (19.4%), and hepatitis C (11.3%). PVT was present in 773 patients (10.0%). Prevalence was higher in MASH/cryptogenic and viral cirrhosis compared with alcohol etiology (11.9%, 11.7% vs. 7.3%). Alcohol etiology was associated with lower odds of PVT [OR 0.64 (95% CI 0.5–0.8), p <0.001]. PVT was more common in patients with diabetes (37.4% vs. 28.9%) and in high-income countries (all p <0.001). Independent predictors of PVT included MASH/cryptogenic etiology [OR 1.59 (95% CI 1.2–2.1), p <0.01], prior portal hypertension–related complications (ascites, variceal bleeding, overt HE, hydrothorax), and non-selective beta-blocker use. PVT associated with higher rates of AKI, grade 3–4 hepatic encephalopathy, 30-day readmission, and liver transplantation (all p <0.05). Thirty-day mortality was higher in patients (22.1% vs. 18.0%; p =0.001), and PVT independently predicted mortality (OR 1.5; 95% CI 1.1–1.9; p <0.001). Conclusions: PVT affects one in ten patients in a global inpatient cirrhosis cohort, and independently predicts short-term mortality and major complications, identifying a high-risk subgroup requiring intensified inpatient and post-discharge care.

Liver Transplantation
Hebei Medical University (CN), Amrita Institute of Medical Sciences and Research Centre (IN), The University of Sydney (AU), University Malaya Medical Centre (MY), Universidade Federal do Rio Grande do Sul (BR), Cleveland Clinic (US), Mayo Clinic (US), Nottingham University Hospitals NHS Trust (GB), Central South University (CN), Nanchang University (CN), Ankara University (TR), Shandong University (CN), University of Alberta (CA), Sun Yat-sen University (CN), Chulalongkorn University (TH), Guangxi Medical University (CN), University of Freiburg (DE), Sanjay Gandhi Post Graduate Institute of Medical Sciences (IN), Christian Medical College, Vellore (IN), Guilin Medical University (CN), Universidade de São Paulo (BR), University of Sierra Leone (SL), Shanghai Jiao Tong University (CN), Virginia Commonwealth University (US), University of Toronto (CA), Jilin University (CN), Akdeniz University (TR), University of Washington (US), Singapore General Hospital (SG), Sichuan University (CN), Fudan University (CN), Wenzhou Medical University (CN), Columbia University Irving Medical Center (US), Royal Perth Hospital (AU), Royal North Shore Hospital (AU), John Hunter Hospital (AU), Renji Hospital (CN), Glasgow Royal Infirmary (GB), Royal Berkshire Hospital (GB), Jacksonville College (US), Jaslok Hospital (IN), Sir Charles Gairdner Hospital (AU), Hospital Italiano de Buenos Aires (AR), Baylor University Medical Center (US), Hospital General de México (MX), WinnMed (US), Guilin University of Aerospace Technology (CN), University of Malaya (MY), California University of Pennsylvania (US), Institute of Physics, Bhubaneshwar (IN), Ege University (TR), Queen Elizabeth Hospital (GB), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (MX), Shanghai University of Traditional Chinese Medicine (CN), Prince of Wales Hospital (AU), Sir Ganga Ram Hospital (IN), Hospital General Dr. Manuel Gea Gonzalez (MX), Mengchao Hepatobiliary Hospital (CN), Mercy Medical Center (US), Hospital Civil de Guadalajara (MX), Apollo Hospitals (IN), Institute of Liver and Biliary Sciences (IN), St George Hospital (AU), Mayo Clinic in Arizona (US), Hospital Geral de Bonsucesso (BR), Centro Médico ABC (MX), Jilin Medical University (CN), Asian Institute of Gastroenterology (IN), Westmead Institute for Medical Research (AU), Affiliated Hospital of Guilin Medical College (CN), Mayo Clinic in Florida (US), Beijing YouAn Hospital (CN), Instituto de Salud del Estado de México (MX), Shuguang Hospital (CN), CM Hospital (KR), Ibn Sina Hospital (KW), Hôpital Mustapha Pacha (DZ), Centre Hospitalier Universitaire de Cocody (CI), St. Paul's Hospital Millennium Medical College (ET), The Fifth People’s Hospital of Suzhou (CN), Cleveland Clinic Abu Dhabi (AE), Post Graduate Institute of Medical Education and Research (IN), University of Manitoba (CA), All India Institute of Medical Sciences (IN), Virginia Commonwealth University Medical Center (US), Marmara University (TR), Helwan University (EG), Chongqing Medical University (CN), University of Hong Kong (HK), Minia University (EG), Sohag University (EG), University of Edinburgh (GB)
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Liver Disease and Transplantation
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