S1791 Comparing Outcomes and Associations in HCC-Related Portal Vein Thrombosis With Non-Malignant Portal Vein Thrombosis: A 5-Year National Inpatient Sample Study

Introduction: Portal vein thrombosis (PVT) is a blockage of the portal vein caused by a blood clot, often due to cirrhosis, malignancy, or other hypercoagulable states involving Virchow's triad: sluggish blood flow, endothelial damage, and increased blood coagulation. In hepatocellular carcinoma (HCC) patients, PVT can also result from direct invasion of the portal vein. This study compares benign PVT and malignant PVT (secondary to HCC) by examining baseline characteristics, risk factors, comorbidities, and in-hospital outcomes. Methods: Using the National Inpatient Sample (NIS) database from 2016 to 2020, we identified hospitalizations with PVT associated with HCC and non-malignant PVT using ICD-10 codes. This retrospective cohort study excluded pregnant women and patients on chronic anticoagulation. Multivariate logistic regression compared outcomes adjusted for baseline characteristics and comorbidities. Results: The study investigated 138,790 PVT cases: 115,185 benign and 23,605 malignant. Benign PVT patients had a mean age of 52.75 years, compared to 63.5 years in malignant cases (P < 0.0001). HCC-PVT was more common in males (75% vs 53%, P < 0.0001), with significant racial differences (P < 0.001). Benign PVT had higher rates of pancreatitis, hyperlipidemia, and obesity (P = 0.01), while malignant PVT was associated with higher rates of chronic kidney disease, type 2 diabetes, chronic viral hepatitis, and cirrhosis (all P < 0.05). Non-malignant PVT had significantly higher incidences of adverse outcomes, including major adverse cardiovascular events, acute mesenteric ischemia, cholestasis, sepsis, cerebrovascular events, and variceal and non-variceal upper GI bleeds (all P < 0.05) (Table 1, Figure 1). Conclusion: Significant differences exist between non-malignant and HCC-associated PVT in demographics, comorbidities, and in-hospital outcomes. HCC-associated PVT patients have higher rates of ascites, while non-malignant PVT patients face higher rates of complications such as upper GI bleeds, acute mesenteric ischemia, and major cardiovascular and cerebrovascular events. These findings underscore the impact of non-malignant PVT on patient outcomes. Further research is needed to develop tailored management strategies to optimize outcomes for these patients.Figure 1.: Baseline characteristics and comorbidities of HCC vs non-malignant PVT. Table 1. - Comparing in-patient outcomes in patients with non-malignant portal vein thrombosis versus hepatocellular carcinoma associated portal vein thrombosis Outcome Benign PVT HCC and PVT Adjusted Odds Ratio P-Value Died during hospitalization 7.40% (8524) 12.84% (3034) 0.9034981 0.134 Ascites 23.72% (27343) 40.78% (9617) 0.8095664 0 Hepatic Encephalopathy 0.59% (679) 0.74% (174) 0.589 0 Cholestasis 4.14% (4776) 5.64% (1332) 0.734 0.039 VUGIB 1.44% (1659) 2.12% (500) 1.475602 0.013 NVUGIB 1.81% (2083) 1.29% (304) 2.473463 0 Acute mesenteric ischemia 2.51% (2892) 0.66% (156) 2.075 0 MACE 0.96% (1106) 0.51% (121) 4.773 0 Cerebrovascular events 0.76% (878) 0.42% (99) 4.914 0 Sepsis 18.52% (21352) 12.40% (2929) 1.770424 0