Harjot Shah1, Sarabmeet Singh Lehl2, Pritam Singh3, Kamal Singh4, Daljinderjit Kaur5
BACKGROUND
Chronic liver disease causes an imbalance in the coagulation system, but available
data on liver disease and risk of venous thrombosis are conflicting. Clinical studies
are therefore needed to understand the prevalence and risk factors associated
with mortality to decide appropriate care of these patients. We studied the
incidence of venous thrombosis in three CTP (Child-Turcotte-Pugh) class of
cirrhotic patients and associated risk factors predicting 90-day mortality.
METHODS
A cross sectional observational study of one-year duration was conducted at a
tertiary-care teaching hospital among patients admitted with chronic liver disease.
150 hospitalised patients with cirrhosis were enrolled and followed up for 3
months. Incidence of thrombosis was recorded in different CTP subclass. Threemonth
mortality rates in different subgroups were compared by using normal test
of proportions. The association between types of thrombosis and CTP class of liver
cirrhosis was studied using Mann-Whitney U test, a non-parametric test. Mortality
association with various parameters was evaluated using non-parametric test. Pvalue
of ≤ 0.05 was considered significant.
RESULTS
Incidence of venous thrombosis in cirrhotic patients was 4 % in this study.
Association of thrombosis with various clinical parameters and different CTP
subclass was statistically non-significant. During the 3-months follow-up 24
patients died. Deceased had higher CTP score (mean CTP score - 9.58) as
compared to survivors (mean CTP - 8.48) (P-value 0.049). Presence of ascites (Pvalue
0.037), higher serum urea (P-value 0.001), creatinine (P = 0.004), and total
leucocyte count (P = 0.008) were significantly associated with mortality.
CONCLUSIONS
Thrombosis in chronic liver disease (CLD) especially portal vein is common and
presents a therapeutic challenge as these patients are also at increased risk of
bleeding. Higher CTP score, serum creatinine, leucocyte count and presence of
ascites in CLD patients at admission are poor prognostic markers.
