OC 04.1 - CiThroModel improves the prediction of venous thromboembolism in hospitalized patients with cirrhosis.

Saturday, June 22, 2024

13:00 – 13:15 ICT

Room: Ballroom B4

Presenting Author(s)

Elena Campello, PhD

Assistant Professor
General Internal Medicine Unit and Thrombotic and Hemorrhagic Disease Unit, Department of Medicine, Padova University Hospital, Padova, Italy
Padova, Veneto, Italy

Co-Author(s)

AZ

Alberto Zanetto

Researcher
Gastroenterology and Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padova University Hospital, Padova, Italy
Padova, Veneto, Italy
FP

Filippo Pelizzaro

Researcher
Gastroenterology and Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padova University Hospital, Padova, Italy
Padova, Veneto, Italy
CB

Cristiana Bulato

PhD
General Internal Medicine Unit and Thrombotic and Hemorrhagic Disease Unit, Department of Medicine, Padova University Hospital, Padova, Italy
Padova, Veneto, Italy
MG

Martina Gambato

MD
Gastroenterology and Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padova University Hospital, Padova, Italy
Padova, Veneto, Italy
GG

Giacomo Germani

MD
Gastroenterology and Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padova University Hospital, Padova, Italy
Padova, Veneto, Italy
LS

Luca Spiezia

Assistant Professor at Department of Medicine
Padua University Hospital
Padova, Veneto, Italy
FR

Francesco Russo

Prof
Gastroenterology and Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padova University Hospital, Padova, Italy
Padova, Veneto, Italy
PB

Patrizia Burra

Prof
Gastroenterology and Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padova University Hospital, Padova, Italy
Padova, Veneto, Italy
MS

Marco Senzolo

MD
Gastroenterology and Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padova University Hospital, Padova, Italy
Padova, Veneto, Italy
Paolo Simioni, MD, PhD

Head of Department of Medicine
University of Padova, Padova University Hospital
Padova, Veneto, Italy

Background: The incidence and risk factors for venous thromboembolism (VTE) in hospitalized patients with cirrhosis are poorly understood.

Aims: We investigated the incidence, risk factors, and clinical impact of VTE in a prospective cohort of patients with cirrhosis.

Methods: Patients were recruited at hospital admission and prospectively followed during hospitalization for development of VTE. Patients receiving anticoagulation and those with cancer were not eligible. Associations with baseline characteristics and 3-months mortality were explored. Hazard ratios (HR) and 95% CIs were calculated using Cox regression.

Results: We included 461 patients (median age 61 years old; 67% male; 52% with alcohol-related cirrhosis). Ascites ± hepatic encephalopathy were the most common reasons for admission. The median MELD score was 18 (12-24); 11% of patients were Child-Pugh A, 41% were Child-Pugh B, and 48% were Child-Pugh C. During hospitalization, 28 (6.1%) patients experienced VTE. Multivariate analysis showed that Child-Pugh C vs. A/B (HR: 5.25; 95% CI: 1.75-15.73), reduced mobility (HR: 4.21; 95% CI: 1.83-9.67), and bacterial infections (HR: 2.35; 95% CI: 1.06-5.12) were independent predictors of VTE. A predictive model (CirrhosisThrombosisModel) based on these variables accurately identified patients at risk (sensitivity 96.3%, specificity 66.7%) (Table). The AUROC of CiThroModel was significantly higher compared with the Padua prediction score (0.842 [0.784-0.899] vs. 0.753 [0.669-0.837]; p=0.04). Regarding 3-month mortality, a multivariate Cox regression model including Child-Pugh stage, AKI, infections, and VTE showed that Child-Pugh stage was the only independent predictor of death.

Conclusion(s): Hospitalized patients with cirrhosis are at significant risk of VTE. Reduced mobility, Child-Pugh stage C, and bacterial infections are independently associated with the risk of developing VTE, thus allowing risk stratification. The CiThroModel can be used to identify the patients at higher risk and guide thromboprophylaxis. Whether VTE in cirrhosis is independently linked to mortality requires further investigation.