Body Adiposity as a Risk Factor for Portal Vein Thrombosis in Patients With Cirrhosis

BACKGROUND & AIMS: Adipose tissue alterations are linked to adverse outcomes in patients with cirrhosis, but their role in portal vein thrombosis (PVT) is unclear. We aimed to evaluate the association between body composition and PVT. METHODS: Cross-sectional study including patients with cirrhosis. Body adiposity was assessed by computed tomography (CT) at the third lumbar vertebra including visceral (VATI), subcutaneous (SATI) and total adipose (TATI) tissue indexes, bioimpedance analysis (BIA) including visceral fat area (VFA), total body fat (TBF) and total body fat percentage (TBF%), and anthropometry. RESULTS: In total, 245 patients with cirrhosis (median age 62 years, 74% male) were included, 17% with PVT. Adiposity was generally higher for PVT versus non-PVT groups but was only significant for BIA-derived TBF [median 25.5 kg (IQR 17.9-35.5) vs. 21.4 (15.1-30.5), p = 0.05]. In logistic regression models adjusted for sex, smoking, spleen size and Child-Pugh score, PVT was associated with higher adiposity by BIA-derived measures (aOR per standard deviation increase: TBF 1.52, 95% CI 1.09-2.11; p = 0.01; TBF% 1.47, 95% CI 1.01-2.14; p = 0.04; VFA 1.41, 95% CI 1.01-1.97; p = 0.047), CT-derived TATI (aOR per standard deviation increase: 1.44, 95% CI 1.02-2.05; p = 0.04) and anthropometry (aOR per standard deviation increase: waist circumference 1.44, 95% CI 1.01-2.08; p = 0.049; hip circumference 1.48, 95% CI 1.04-2.12; p = 0.03). Larger spleen size was consistently associated with a 46%-57% increase (per standard deviation) in likelihood of PVT across models (all p < 0.05). CONCLUSION: PVT was associated with both greater adiposity and larger spleen size, suggesting that, in addition to portal hypertension, adiposity may be a risk factor for PVT development through an inflammatory/prothrombotic role among patients with cirrhosis.