Abstract: Objective:To investigate the risk factors for portal vein system thrombosis (PVST) in severe acute pancreatitis (SAP).
Methods:The retrospective case-control study was conducted. The clinical data of 198 patients with SAP who were admitted to the Hunan Provincial People′s Hospital from November 2014 to December 2017 were collected. There were 117 males and 81 females, aged from 18 to 79 years, with a median age of 49 years. Of the 198 patients, 27 were diagnosed with PVST and 171 diagnosed without PVST. Observation indicators: (1) analysis of risk factors for PVST in SAP; (2) follow-up. Follow-up was conducted for 12 months by outpatient examination or telephone interview to detected patients survival up to January 2019. Measurement data of normal distribution were represented as Mean±SD, and measurement data of skew distribution were represented as M (range). Count data were expressed as absolute numbers or percentages. Univariate analysis was conducted using the chi-square test. Multivariate analysis was conducted using the Logistic regression model.
Results:(1) Analysis of risk factors for PVST in SAP: results of univariate analysis showed that the prothrombin time, level of C-reactive protein, level of D-Dimer and score of modified CT severity index (MCTSI) were related factors for PVST in patients (x²=8.580, 11.946, 15.445, 13.276, P<0.05). Results of multivariate analysis showed that the prothrombin time>13 seconds, level of C-reactive protein>200 mg/L, level of D-Dimer>4 mg/L and score of MCTSI as 6-10 were independent risk factors for PVST in patients with SAP (odds ratio = 3.465, 7.659, 7.914, 4.719, 95% confidence interval: 1.271-9.443, 2.464-23.805, 2.764-22.659, 1.694-13.144, P<0.05). (2) Follow-up: all the 198 patients with SAP were followed up for 12 months. None of the 27 patients with SAP who were diagnosed with PVST died during hospitalization, and 5 of the 27 patients died of SAP or the complications within 2 months after discharge with the mortality of 18.52% (5/27). Five of the 171 patients with SAP who were diagnosed without PVST died during hospitalization, and 15 of the 166 patients who were discharged died of SAP or the complications within 2 months after discharge with the mortality of 11.70%(20/171). There were no significant difference in mortality between patients with or without PVST (x²=0.984, P>0.05).
Conclusion:The prothrombin time>13 seconds, level of C-reactive protein>200 mg/L, level of D-Dimer>4 mg/L and score of MCTSI as 6-10 are independent risk factors for PVST in patients with SAP.