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Cirrhosis is Associated with an Increased 30-Day Mortality After Venous Thromboembolism.

Søgaard KK, Horváth-Puhó E, Montomoli J, Vilstrup H, Sørensen HT - Clin Transl Gastroenterol (2015)

Bottom Line: We obtained information on immediate cause of death for patients who died within 30 days after VTE.Corresponding PE-related mortality risks were 35% and 16%, and PVT-related mortality risks were 19% and 15%, respectively.The adjusted 30-day MRRs were 2.17 (1.24-3.79) for DVT, 1.83 (1.30-2.56) for PE, and 1.30 (0.80-2.13) for PVT.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.

ABSTRACT

Objectives: Patients with cirrhosis are at increased risk of venous thromboembolism (VTE), but the impact of cirrhosis on the clinical course following VTE is unclear. In a nationwide cohort study, we examined 30-day mortality among patients with cirrhosis and VTE.

Methods: We used Danish population-based health-care databases (1994-2011) to identify patients with incident VTE, i.e., deep venous thrombosis (DVT), pulmonary embolism (PE), and portal vein thrombosis (PVT). Among these, we identified 745 patients with cirrhosis and 3647 patients without cirrhosis (matched on gender, year of birth, calendar year of VTE diagnosis and VTE type). We assessed the 30-day mortality risk among VTE patients with and without cirrhosis, and the mortality rate ratios (MRRs), using an adjusted Cox model with 95% confidence interval. We obtained information on immediate cause of death for patients who died within 30 days after VTE.

Results: The 30-day mortality risk for DVT was 7% for patients with cirrhosis and 3% for patients without cirrhosis. Corresponding PE-related mortality risks were 35% and 16%, and PVT-related mortality risks were 19% and 15%, respectively. The adjusted 30-day MRRs were 2.17 (1.24-3.79) for DVT, 1.83 (1.30-2.56) for PE, and 1.30 (0.80-2.13) for PVT. Though overall mortality was higher in patients with cirrhosis than patients without cirrhosis, the proportions of deaths due to PE were similar among patients (25% and 24%, respectively).

Conclusions: Cirrhosis is a predictor for increased short-term mortality following VTE, with PE as the most frequent cause of death.

No MeSH data available.


Related in: MedlinePlus

Thirty-day mortality risk (%) among patients with venous thromboembolism. Note that different scales were used for mortality risk (%).
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fig1: Thirty-day mortality risk (%) among patients with venous thromboembolism. Note that different scales were used for mortality risk (%).

Mentions: Within 30 days of follow-up, DVT patients with cirrhosis were at higher risk of death than DVT patients without cirrhosis (Figure 1). The 30-day mortality risk following a DVT diagnosis was 7% (95% CI: 5–10%) among patients with cirrhosis and 3% (95% CI: 2–3%) among patients without cirrhosis (Table 2). In a subgroup analysis of patients with cancer, 30-day mortality risks were slightly higher in DVT patients with cirrhosis (absolute risk=15% (95% CI: 8–26%)) compared with DVT patients without cirrhosis (absolute risk=9% (95% CI: 6–12%)). Cirrhosis increased the risk of dying after a DVT event (adjusted MRR=2.17 (95% CI: 1.24–3.79)) (Table 2). All types of cirrhosis seemed to increase mortality rates compared with patients without cirrhosis, although for patients with biliary cirrhosis the estimate was based on a small number of deaths (Table 2). The impact of cirrhosis on the relative mortality after DVT was higher among patients without other pre-existing comorbidities than patients with moderate or severe comorbidity level, compared with patients without cirrhosis but with similar comorbidity level (Table 3). Correspondingly, the MRR was higher for patients without previous cancer than in patients with cancer (Table 3), which likely reflects confounding by baseline risk.


Cirrhosis is Associated with an Increased 30-Day Mortality After Venous Thromboembolism.

Søgaard KK, Horváth-Puhó E, Montomoli J, Vilstrup H, Sørensen HT - Clin Transl Gastroenterol (2015)

Thirty-day mortality risk (%) among patients with venous thromboembolism. Note that different scales were used for mortality risk (%).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4816257&req=5

fig1: Thirty-day mortality risk (%) among patients with venous thromboembolism. Note that different scales were used for mortality risk (%).
Mentions: Within 30 days of follow-up, DVT patients with cirrhosis were at higher risk of death than DVT patients without cirrhosis (Figure 1). The 30-day mortality risk following a DVT diagnosis was 7% (95% CI: 5–10%) among patients with cirrhosis and 3% (95% CI: 2–3%) among patients without cirrhosis (Table 2). In a subgroup analysis of patients with cancer, 30-day mortality risks were slightly higher in DVT patients with cirrhosis (absolute risk=15% (95% CI: 8–26%)) compared with DVT patients without cirrhosis (absolute risk=9% (95% CI: 6–12%)). Cirrhosis increased the risk of dying after a DVT event (adjusted MRR=2.17 (95% CI: 1.24–3.79)) (Table 2). All types of cirrhosis seemed to increase mortality rates compared with patients without cirrhosis, although for patients with biliary cirrhosis the estimate was based on a small number of deaths (Table 2). The impact of cirrhosis on the relative mortality after DVT was higher among patients without other pre-existing comorbidities than patients with moderate or severe comorbidity level, compared with patients without cirrhosis but with similar comorbidity level (Table 3). Correspondingly, the MRR was higher for patients without previous cancer than in patients with cancer (Table 3), which likely reflects confounding by baseline risk.

Bottom Line: We obtained information on immediate cause of death for patients who died within 30 days after VTE.Corresponding PE-related mortality risks were 35% and 16%, and PVT-related mortality risks were 19% and 15%, respectively.The adjusted 30-day MRRs were 2.17 (1.24-3.79) for DVT, 1.83 (1.30-2.56) for PE, and 1.30 (0.80-2.13) for PVT.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.

ABSTRACT

Objectives: Patients with cirrhosis are at increased risk of venous thromboembolism (VTE), but the impact of cirrhosis on the clinical course following VTE is unclear. In a nationwide cohort study, we examined 30-day mortality among patients with cirrhosis and VTE.

Methods: We used Danish population-based health-care databases (1994-2011) to identify patients with incident VTE, i.e., deep venous thrombosis (DVT), pulmonary embolism (PE), and portal vein thrombosis (PVT). Among these, we identified 745 patients with cirrhosis and 3647 patients without cirrhosis (matched on gender, year of birth, calendar year of VTE diagnosis and VTE type). We assessed the 30-day mortality risk among VTE patients with and without cirrhosis, and the mortality rate ratios (MRRs), using an adjusted Cox model with 95% confidence interval. We obtained information on immediate cause of death for patients who died within 30 days after VTE.

Results: The 30-day mortality risk for DVT was 7% for patients with cirrhosis and 3% for patients without cirrhosis. Corresponding PE-related mortality risks were 35% and 16%, and PVT-related mortality risks were 19% and 15%, respectively. The adjusted 30-day MRRs were 2.17 (1.24-3.79) for DVT, 1.83 (1.30-2.56) for PE, and 1.30 (0.80-2.13) for PVT. Though overall mortality was higher in patients with cirrhosis than patients without cirrhosis, the proportions of deaths due to PE were similar among patients (25% and 24%, respectively).

Conclusions: Cirrhosis is a predictor for increased short-term mortality following VTE, with PE as the most frequent cause of death.

No MeSH data available.


Related in: MedlinePlus