Publication: High Incidence of Hepatitis B Infection-Associated Cirrhosis and Hepatocellular Carcinoma in the Southeast Asian Patients with Portal Vein Thrombosis
Issued Date
2011
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eng
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Mahidol University
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BioMed Central
Bibliographic Citation
BMC Gastroenterology. Vol. 11, (2011), 66
Suggested Citation
Korn Lertpipopmetha, Chirayu U Auewarakul High Incidence of Hepatitis B Infection-Associated Cirrhosis and Hepatocellular Carcinoma in the Southeast Asian Patients with Portal Vein Thrombosis. BMC Gastroenterology. Vol. 11, (2011), 66. doi:10.1186/1471-230X-11-66 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/2643
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Title
High Incidence of Hepatitis B Infection-Associated Cirrhosis and Hepatocellular Carcinoma in the Southeast Asian Patients with Portal Vein Thrombosis
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Abstract
Background: Portal vein thrombosis (PVT) is a rare condition associated with serious morbidity and mortality. The
objective of this study was to determine the frequency, clinical presentations, and risk factors of PVT from the set
of data firstly collected among the Southeast Asian population.
Methods: A retrospective study was undertaken to identify patients diagnosed with thrombosis of the portal
system and other abdominal veins. The hospital medical records were retrieved based on the selected ICD-10
codes. Clinical presentations were collected and risk factors determined.
Results: From 2000-2009, 467 hospital charts with designated ICD-10 codes of I81, I82.2, I82.3, I82.8, I82.9, or K55.0
were identified. PVT (I81) was the most common thrombosis (194 cases, 41.54%). The majority of PVT patients were
males (65%), older than 40 years (75%), and presented with abdominal distension/ascites (69%), splenomegaly
(54.6%), and abdominal pain (50.5%). Overall, the predominant risk factor was hepatocellular carcinoma (HCC)
(52.5%), followed by liver cirrhosis without cancer (9.3%), abdominal infection/inflammation (9.3%),
cholangiocarcinoma (8.2%), and abdominal intervention (7.7%). In young patients, abdominal interventions
including umbilical catheterization (23.1%) and hepatectomy (7.7%) were the most frequent risks whereas in older
cases, primary hepatobiliary cancer and cirrhosis (78%) were the major risks. Liver metastases from other organs
were infrequently found. Chronic hepatitis B virus (HBV) infection was the main etiology associated with cirrhosis/
HCC leading to PVT in this cohort. A third of the older PVT patients (age >40) had HBV and very few carried
hepatitis C virus (HCV) whereas none of the young PVT patients (age <20) had HBV or HCV. A variety of abdominal
infections/inflammations were also found including liver abscess, splenic abscess, cholangitis, cholecystitis,
pancreatitis, omphalitis, and abdominal tuberculosis. Single cases of systemic lymphangiomatosis and Klippel-
Trénaunay vascular malformation syndrome were also identified. Other thrombophilic conditions such as
myeloproliferative neoplasms, paroxysmal nocturnal hemoglobinuria, protein S deficiency, and anti-phospholipid
syndrome were rarely encountered.
Conclusion: HBV is the major risk of PVT in the Southeast Asian population. Several risk factors identified in this
population have rarely been described and some are remarkably different from those reported in the West. Host
and environmental factors may play a causal role in the initiation and development of PVT in various ethnicities
and geographic locations.