Visceral fat is associated with cirrhotic portal vein thrombosis

ABSTRACT

Background: Central obesity, due to the accumulation of visceral fat(VF), is one of the main risk factors for venous thrombosis. The aim of this study was to determine if VF may be a risk factor for development of portal vein thrombosis(PVT) in cirrhotic patients.

Methods: A total of 214 cirrhotic patients at the outpatient clinic were consecutively included, undergoing an anthropometric evaluation, blood tests and bioimpedance.

Results: Median MELDscore was10. Prior liver decompensation occurred in 44.9% of patients and 35.6% of patients had large esophageal varices. Mean body mass index was 28.7 Kg/m2 (39.3%were obese) and mean waist circumference(WC) was 103.8 cm. A 7.5% of patients had PVT at the time of inclusion. PVT was more frequent in males(93.8 vs. 68.2%, p = 0.03). Patients with PVT had a higher WC(111.9 vs. 103.2 cm, p = 0.02) and VF (17.1 vs. 14.5, p = 0.04). PVT was also more frequent in patients with prior decompensation (81.3 vs. 41.9%, p < 0.01) and with large esophageal varices(62.5 vs. 33.3%, p = 0.02). In the simplified multivariate analysis, PVT was independently associated with the presence of portal hypertension(OR 13, 95%CI 1.6–108.3, p = 0.02) and VF(OR 1.2, 95%CI 1.03–1.3, p = 0.01).

Conclusion: VF was independently associated with PVT in cirrhotic patients. VF may be more reliable than conventional anthropometric measurements for cirrhotic patients.

KEYWORDS:

• Portal vein thrombosis
• visceral fat
• liver cirrhosis
• bioelectrical impedance analysis

Article highlights

• Body fat distribution (central obesity) predicts the risk for venous thromboembolism.

• An increased waist circumference denoting central obesity due to visceral fat (VF) accumulation may be the risk factor for developing portal vein thrombosis (PVT) in non-cirrhotic patients but not in cirrhotic patients.

• VF measured by bioelectrical impedance analysis is independently associated with PVT in cirrhotic patients (OR 1.2, 95%CI 1.04–1.4).

• The optimal cutoff of VF for PVT prediction would be 14 (AUROC 0.7, 95%CI 0.6–0.8).

• BMI is a marker of excess body weight, although it fails to consider the distribution of such body fat (subcutaneous or visceral fat).

Declaration of interest

J.L. Calleja has served as a speaker and consultant for Abbvie, Gilead and MSD. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.