Journal Article

Predicting de‐novo portal vein thrombosis after HCV eradication: A long‐term competing risk analysis in the ongoing PITER cohort

Federico, Alessandro, Zanetto, Alberto, Martina Loi, Nardone, Gerardo, Licata, Anna, Coppola, Nicola, Monica Monti, Barbara Coco, Russo, Francesco Paolo, Panetta, Valentina, Chemello, Liliana, Valentina Cossiga, Costantino Sgamato, Marcello Dallio, Giovanni Battista Gaeta, Baiocchi, Leonardo, Kondili, Loreta A, Calvaruso, Vincenza, Mario Masarone, Zignego, Anna Linda, Antonio Ciaccio, Craxì, Antonio, Invernizzi, Pietro, Raimondo, Giovanni, Persico, Marcello, Lucia Brescini, Caterina Sagnelli, Madonia, Salvatore, Roberto Filomia, Chessa, Luchino, Ferrigno, Luigina, Simona Amodeo, Martina De Siena, Ernesto Claar, Benedetti, Antonio, Luciano Crapanzano, Giacometti, Andrea, Brunetto, Maurizia R, Ciancio, Alessia, Xhimi Tata, Paolo Simioni, Pompili, Maurizio, Erica Maria Bruno, Iannone, Andrea, Elena Rosselli Del Turco, Coppola, Carmine, Gentile, Ivan, Maria Grazia Rumi, Quaranta, Maria Giovanna, Cavalletto, Luisa, Barbaro, Francesco, Brancaccio, Giuseppina, Piscaglia, Fabio, Morisco, Filomena, Monica Cucco, Ilaria Serio, Biliotti, Elisa, Ieluzzi, Donatella, Cerini, Federica

2024

Overview

Background & Aims Sustained virological response (SVR) by direct‐acting antivirals (DAAs) may reverse the hypercoagulable state of HCV cirrhosis and the portal vein thrombosis (PVT) risk. We evaluated the incidence and predictive factors of de novo, non‐tumoral PVT in patients with cirrhosis after HCV eradication. Methods Patients with HCV‐related cirrhosis, consecutively enrolled in the multi‐center ongoing PITER cohort, who achieved the SVR using DAAs, were prospectively evaluated. Kaplan‐Meier and competing risk regression analyses were performed. Results During a median time of 38.3 months (IQR: 25.1–48.7 months) after the end of treatment (EOT), among 1609 SVR patients, 32 (2.0%) developed de novo PVT. A platelet count ≤120,000/μL, albumin levels ≤3.5 mg/dL, bilirubin >1.1 mg/dL, a previous liver decompensation, ALBI, Baveno, FIB‐4, and RESIST scores were significantly different (p < 0.001), among patients who developed PVT versus those who did not. Considering death and liver transplantation as competing risk events, esophageal varices (subHR: 10.40; CI 95% 4.33–24.99) and pre‐treatment ALBI grade ≥2 (subHR: 4.32; CI 95% 1.36–13.74) were independent predictors of PVT. After HCV eradication, a significant variation in PLT count, albumin, and bilirubin (p < 0.001) versus pre‐treatment values was observed in patients who did not develop PVT, whereas no significant differences were observed in those who developed PVT (p > 0.05). After the EOT, esophageal varices and ALBI grade ≥2, remained associated with de novo PVT (subHR: 9.32; CI 95% 3.16–27.53 and subHR: 5.50; CI 95% 1.67–18.13, respectively). Conclusions In patients with HCV‐related cirrhosis, a more advanced liver disease and significant portal hypertension are independently associated with the de novo PVT risk after SVR.

• Publisher: Wiley,John Wiley & Sons, Inc
• Subject: Abdomen / Albumins - therapeutic use / Antiviral Agents - therapeutic use / Antiviral drugs / Bilirubin / Case reports / coagulation / coagulation, direct-acting antiviral, long term outcomes, predictive factors, predictive factors, real-life cohort / coagulation; direct-acting antiviral; long term outcomes; predictive factors; real-life cohort / direct-acting antiviral / Esophageal and Gastric Varices - complications / Esophagus / Hepatitis C / Hepatitis C, Chronic - complications / Hepatitis C, Chronic - diagnosis / Hepatitis C, Chronic - drug therapy / Hepatobiliary / Humans / Hypertension / Liver cancer / Liver cirrhosis / Liver Cirrhosis - complications / Liver Cirrhosis - diagnosis / Liver Cirrhosis - epidemiology / Liver diseases / long term outcomes / Medical imaging / Mortality / Patients / Population / Portal Vein / predictive factors / real-life cohort / Risk Assessment / Thrombosis / Ultrasonic imaging / Variables / Veins & arteries / Venous Thrombosis - diagnosis / Venous Thrombosis - epidemiology / Venous Thrombosis - etiology