Hypoalbuminemia and Risk of Portal Vein Thrombosis in Cirrhosis

BACKGROUND AND AIMS: Hypoalbuminemia, as defined by serum albumin (SA) levels 35 g/L, is associated to venous and arterial thrombosis in general population and in patients at risk of cardiovascular disease. It is unknown if SA 35 g/L is also associated to portal vein thrombosis (PVT) in cirrhosis. METHODS: Cirrhotic patients enrolled in the Portal vein thrombosis Relevance On Liver cirrhosis: Italian Venous thrombotic Events Registry (PRO-LIVER) study (n ¼ 753), were followed-up for 2 years to assess the risk of PVT, that was diagnosed by Doppler ultrasonography. Child-Pugh classes, Model for End-Stage Liver Disease score, presence of hepato- cellular carcinoma and laboratory variables including SA, D- dimer, and high-sensitivity C-reactive protein (hs-CRP) were measured at baseline. RESULTS: SA 35 g/L was detected in 52% of patients. A logistic multivariate regression analysis showed that higher Child-Pugh class, hepatocellular carcinoma and thrombocytopenia were significantly associated to SA 35 g/L. In a subgroup of patients where data regarding hs-CRP and D-dimer were available, SA 35 g/L was inversely associated with hs-CRP and D-dimer. During the follow-up, a total of 61 patients experienced PVT. A Kaplan Meier survival analysis showed SA 35 g/L was associated to increased risk of PVT compared to SA >35 g/L (P ¼ .005). A multivariate Cox pro- portional hazards regression analysis showed that male sex, lower platelet count, and SA 35 g/L remained associated to PVT after adjusting for confounding factors. CONCLUSION: Cirrhotic patients with SA 35 g/L are at higher risk of expe- riencing PVT compared to those with SA >35 g/L and could be considered as potential candidates to anticoagulant prophylaxis for PVT prevention.