Published online Sep 21, 2018. doi: 10.3748/wjg.v24.i35.4054
Peer-review started: May 4, 2018
First decision: June 6, 2018
Revised: June 17, 2018
Accepted: June 25, 2018
Article in press: June 25, 2018
Published online: September 21, 2018
To investigate the incidence and risk factors of portosplenomesenteric vein thrombosis (PSMVT) in the early stage of severe acute pancreatitis (SAP).
Patients with SAP in a tertiary care setting from January 2014 to December 2016 were retrospectively reviewed. All contrast-enhanced computed tomography (CT) studies were reassessed and reviewed. Clinical outcome measures were compared between SAP patients with and without PSMVT in the early stage of the disease. Univariate and multivariate logistic regression analyses were sequentially performed to assess potential risk factors for the development of PSMVT in SAP patients. A receiver operating characteristic (ROC) curve was generated for the qualifying independent risk factors.
Twenty-five of the one hundred and forty (17.86%) SAP patients developed PSMVT 6.19 ± 2.43 d after acute pancreatitis (AP) onset. PSMVT was confirmed by contrast-enhanced CT. Multivariate stepwise logistic regression analyses showed that Balthazar’s CT severity index (CTSI) scores [odds ratio (OR): 2.742; 95% confidence interval (CI): 1.664-4.519; P = 0.000], hypoalbuminemia (serum albumin level < 25 g/L) (OR: 32.573; 95%CI: 2.711-391.353; P = 0.006) and gastrointestinal wall thickening (OR: 4.367, 95%CI: 1.218-15.658; P = 0.024) were independent risk factors for PSMVT developed in patients with SAP. The area under the ROC curve for Balthazar’s CTSI scores was 0.777 (P = 0.000), the sensitivity was 52%, and the specificity was 93% at a cut-off value of 5.5.
High Balthazar’s CTSI scores, hypoalbuminemia and gastrointestinal wall thickening are independent risk factors for PSMVT developed in the early stage of SAP.
Core tip: Studies on portosplenomesenteric vein thrombosis (PSMVT) occurring in the early stage of acute pancreatitis (AP) were rare. We found that 17.86% of severe AP patients developed PSMVT 6.19 d after AP onset. High Balthazar’s computed tomography severity index (CTSI) scores, hypoalbuminemia and gastrointestinal wall thickening are independent risk factors for the development of PSMVT, and Balthazar’s CTSI scores can predict the occurrence of PSMVT with a high degree of specificity which indicated that a low Balthazar’s CTSI score could be a good indicator that PSMVT would not occur.