Epidemiology and Risk Factors of Portal Venous System Thrombosis in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Hanyang Lin; Zhaohui Bai; Fanjun Meng; Yanyan Wu; Li Luo; Akash Shukla; Eric M Yoshida; Xiaozhong Guo; Xingshun Qi

doi:10.3389/fmed.2021.744505

Epidemiology and Risk Factors of Portal Venous System Thrombosis in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Front Med (Lausanne). 2022 Jan 17:8:744505. doi: 10.3389/fmed.2021.744505. eCollection 2021.

Authors

Hanyang Lin^{1

2}, Zhaohui Bai^{1

3}, Fanjun Meng¹, Yanyan Wu^{1

4}, Li Luo^{1

4}, Akash Shukla⁵, Eric M Yoshida⁶, Xiaozhong Guo¹, Xingshun Qi¹

Affiliations

¹ Department of Gastroenterology, General Hospital of Northern Theater Command (formerly called General Hospital of Shenyang Military Area), Shenyang, China.
² China Medical University, Shenyang, China.
³ Shenyang Pharmaceutical University, Shenyang, China.
⁴ Jinzhou Medical University, Jinzhou, China.
⁵ Department of Gastroenterology, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India.
⁶ Division of Gastroenterology, Vancouver General Hospital, Vancouver, BC, Canada.

Abstract

Background: Patients with inflammatory bowel disease (IBD) may be at risk of developing portal venous system thrombosis (PVST) with worse outcomes. This study aims to explore the prevalence, incidence, and risk factors of PVST among patients with IBD.

Methods: PubMed, Embase, and Cochrane Library databases were searched. All the eligible studies were divided according to the history of colorectal surgery. Only the prevalence of PVST in patients with IBD was pooled if the history of colorectal surgery was unclear. The incidence of PVST in patients with IBD after colorectal surgery was pooled if the history of colorectal surgery was clear. Prevalence, incidence, and risk factors of PVST were pooled by only a random-effects model. Subgroup analyses were performed in patients undergoing imaging examinations. Odds ratios (ORs) with 95% CIs were calculated.

Results: A total of 36 studies with 143,659 patients with IBD were included. Among the studies where the history of colorectal surgery was unclear, the prevalence of PVST was 0.99, 1.45, and 0.40% in ulcerative colitis (UC), Crohn's disease (CD), and unclassified IBD, respectively. Among the studies where all the patients underwent colorectal surgery, the incidence of PVST was 6.95, 2.55, and 3.95% in UC, CD, and unclassified IBD after colorectal surgery, respectively. Both the prevalence and incidence of PVST became higher in patients with IBD undergoing imaging examinations. Preoperative corticosteroids therapy (OR = 3.112, 95% CI: 1.017-9.525; p = 0.047) and urgent surgery (OR = 1.799, 95% CI: 1.079-2.998; p = 0.024) are significant risk factors of PVST in patients with IBD after colorectal surgery. The mortality of patients with IBD with PVST after colorectal surgery was 4.31% (34/789).

Conclusion: PVST is not rare, but potentially lethal in patients with IBD after colorectal surgery. More severe IBD, indicated by preoperative corticosteroids and urgent surgery, is associated with a higher risk of PVST after colorectal surgery. Therefore, screening for PVST by imaging examinations and antithrombotic prophylaxis in high-risk patients should be actively considered.

Systematic review registration: Registered on PROSPERO, Identifier: CRD42020159579.

Keywords: epidemiology; inflammatory bowel disease; meta-analysis; portal venous system thrombosis; risk factor.

Publication types

Systematic Review