The Clinical Value Of DIC Score In The Prediction Of Portal Vein Thrombosis In Cirrhosis

Objective:Portal vein thrombosis is a common and serious complication of patients with liver cirrhosis,which will furtuer increase the pressure of portal vein,increase the risk of gastrointestinal bleeding,hepatic encephalopathy,intractable ascites and so on.PVT is often misdiagnosed because of its occult onset and atypical clinical symptoms.Therefore,early assessment of the risk of PVT in cirrhosis is of great significance.The DIC score is obtained by adding the scores corresponding to the four parameter values of PLT,DD,PT and FIB.Compared with a single coagulation index,it can better reflect the coagulation status of patients with cirrhosis.In this article,,we retrospectively analyzed the clinical data of cirrhosis with portal vein thrombosis(PVT group)and cirrhosis without portal vein thrombosis(without PVT group),to explore the clinical application value of DIC score and other indicators for portal vein thrombosis in cirrhosis,and to evaluate patients' quality of life and survival rate.Methods:From August 2016 to August 2019,107 patients with cirrhosis and portal vein thrombosis admitted to the Department of Gastroenterology,the Second Affiliated Hospital of Kunming Medical University were selected as the experimental group(PVT group),and 112 patients with cirrhosis and no portal vein thrombosis in the same period were randomly selected as the control group(no PVT group).Both groups of patients collected the following information:? general information:gender,age,body mass index(BMI),etiology;? past and surgical history:history of smoking,drinking,hypertension,diabetes,upper gastrointestinal bleeding,splenectomy or splenic embolism.and TIPS;?Clinical complications:upper gastrointestinal bleeding,hepatic encephalopathy(HE),spontaneous bacterial peritonitis(SBP);?laboratory tests:white blood cell count(WBC),red blood cell count(RBC),Hemoglobin(HGB).Blood platelet count(PLT),total protein(TP),albumin(ALB),alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),blood urea nitrogen(BUN),serum creatinine(SCr),prothrombin time(PT),activated partial thrombin time(APTT),thrombin time(TT),antithrombin(AT),fibrinogen(FIB),Fibrinogen degradation products(FDPs),international standardized ratio(INR),D-dimer(DD);? imaging examination:portal vein inner diameter,splenic vein diameter,spleen length,spleen thickness,degree of ascites,thrombus site:? Reserves:Indocyanine green 15 minutes retention(ICGR15),effective liver blood flow(EHBF);?related scores and ratios:Child-Pugh score,MELD score,APRI score.FIB-4 index.DIC score,plasma D-Dimer/fibrinogen ratio(D/F).For the measurement data of normal distribution,the independent sample t-test was used for the comparison between two groups,and the single factor analysis of variance was used for the comparison between multiple groups;the Mann Whitney U test was used for the comparison between two groups of non normal distribution,and the Kruskal Wallis h test was used for the comparison between multiple groups;the x 2 test or Fisher exact probability method was used for the comparison between the count data groups.Multivariate logistic regression analysis was used to screen independent risk factors of PVT formation in cirrhosis,and draw receiver operating characteristic curve(ROC)to compare the predictive value of influencing factors.Results:1.The results of univariate analysis showed that there was no significant difference in gender,age,BMI,etiology,smoking history,drinking history,hypertension history,diabetes history,splenectomy or splenic embolization operation history,tips operation history,hepatic encephalopathy,spontaneous bacterial peritonitis,WBC,TBIL,APTT.TT,AT,EHBF,MELD score,APRI score and FIB-4 index between PVT group and non PVT group(P>0.05);There were significant differences in the past history of upper gastrointestinal bleeding,gastrointestinal bleeding,RBC,HGB,PLT,TP,ALB,ALT,AST,BUN,SCr,PT,FIB,FDPs,INR,DD,portal vein inner diameter,splenic vein diameter,spleen length,spleen thickness,degree of ascites,ICGR15,Child-Pugh score,DIC score and D/F ratio(P<0.05).2.Multivariate analysis:the items with P<0.05 in univariate analysis were included in multivariate logistic regression model for analysis.The results showed that the patients had the history of upper gastrointestinal bleeding(B:1.117,or:3.056,95%CI:1.519-6.146,P:0.002),upper gastrointestinal bleeding(B:0.786,or:2.195,95%CI:1.042-4.624,P:0.039),SCr(B:0.019,or:1.019,95%CI:1.002-1.037,P:0.025)And DIC score(B:0.471,or:1.601,95%CI:1.289-1.988,P:0.000)were independent risk factors for PVT formation in cirrhosis.Among them,DIC score predicted AUC of PVT formation in cirrhosis was 0.746(95%CI:0.681-0.812,P<0.05),the maximum value of calculated Jordan index was 0.436,the corresponding cut-off value was 2.5,the corresponding sensitivity was 75.7%and the specificity was 67.9%;SCr predicted AUC of PVT formation in cirrhosis was 0.610(95%CI:0.535-0.685,P<0.05),the maximum value of calculated Jordan index was 0.243,the corresponding cut-off value was 64.5umol/L,the corresponding sensitivity was 65.4%and the specificity was 58.9%.3.There was no difference in DIC score between portal vein thrombosis groups in different sites or degrees.Conclusions:1.DIC score can be used as a predictor of PVT formation in patients with cirrhosis.When the score is more than 2.5,we should be alert to the occurrence of PVT.Although DIC score has a certain predictive value for the formation of PVT in cirrhosis,it has no predictive value for the location and severity of portal vein thrombosis.2.The independent risk factors of PVT were the history of upper gastrointestinal bleeding,upper gastrointestinal bleeding,SCR and DIC scoreDIC score can be used as a predictor of PVT formation in cirrhosis.