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Clinical Characteristics and Risk Factors for Sinistral Portal Hypertension Associated with Moderate and Severe Acute Pancreatitis: A Seven-Year Single-Center Retrospective Study

Hui Li, Zhenyu Yang, Feng Tian

(Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China (mainland))

Med Sci Monit 2019; 25:5969-5976

DOI: 10.12659/MSM.916192

BACKGROUND: This study aimed to assess the prevalence, clinical characteristics, and risk factors for sinistral portal hypertension in patients with moderate or severe acute pancreatitis.
MATERIAL AND METHODS: A retrospective study included 825 patients with moderate or severe acute pancreatitis. Clinical and demographic data, the Acute Physiology and Chronic Health Evaluation (APACHE II) and the Ranson scores for severity of acute pancreatitis, and the computed tomography (CT) severity index (CTSI) were evaluated. The formation of collateral vessels, bleeding, splenomegaly, hypersplenism during hospitalization or follow-up, and early anticoagulation and the occurrence of sinistral portal hypertension were evaluated.
RESULTS: Of the 825 patients with moderate or severe acute pancreatitis, 103 patients (12.5%) developed sinistral portal hypertension. The median time to diagnosis was 8 months, and the median patient age was 39 years. The most common causes of pancreatitis were biliary (46.3%), hypertriglyceridemia (31.5%), alcohol (14.9%), and others (7.3%). Independent risk factors for sinistral portal hypertension were male gender (OR, 4.666; 95% CI, 2.54-8.572; P<0.001), recurrent acute pancreatitis (OR, 9.556; 95% CI, 5.218-17.5; P<0.001), hypertriglyceridemia (OR, 2.056; 95% CI, 1.184-3.57; P=0.001), glucose >10 mmol/L (OR, 6.965; 95% CI, 4.027-12.045; P<0.001), smoking (OR, 6.32; 95% CI, 3.544-11.269; P<0.001), and infection of walled-off necrosis (OR=1.637; 95% CI, 1.061-2.524; P=0.015). Anticoagulation during hospitalization was not significantly associated with sinistral portal hypertension.
CONCLUSIONS: Hypertriglyceridemia, hyperglycemia, infection of walled-off necrosis, recurrent acute pancreatitis, and smoking were risk factors for sinistral portal hypertension, and early anticoagulation did not prevent the occurrence.

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