Portal Vein Thrombosis is a Potential Complication of Coronavirus Disease 2019 in Cirrhotic Patients

Abstract

Background. According to multiple reports, the incidence of thromboembolic complications has increased in patients infected with coronavirus disease 2019 (COVID-19), particularly in the elderly patients with severe illness and comorbid diseases such as diabetes and hypertension. Portal vein thrombosis (PVT) is a silent and rare venous thromboembolic disease occurring typically in patients with an underlying chronic liver disease, such as decompensated cirrhosis with or without hepatocellular carcinoma (HCC). This study aims to evaluate the incidence of occurrence of acute PVT in cirrhotic patients infected with COVID-19.
Methods. This observational study involved 70 cirrhotic patients who were classified into Group A comprising 28 cirrhotic patients infected with COVID19, and Group B comprising 42 age- and sex-matched patients with liver cirrhosis as controls. All patients underwent a thorough medical history and examination. Routine investigations included complete blood count, liver, and renal function tests. Furthermore, imaging techniques such as abdominal and Doppler ultrasonography were used to determine the presence of acute PVT. Levels of serum ferritin, D-dimer, and C-reactive protein were determined, and COVID-19 RT-PCR was conducted for patients of Group A only.
Results. Doppler ultrasound examination revealed a significant difference in the number of patients affected by PVT between the two groups. Three patients of Group A (10.7 %) and only one patient of Group B (2.3%) had PVT (P < 0.05).
Conclusion. Even in the absence of HCC, PVT could be a potential complication of COVID-19 in cirrhotic patients. Further prospective studies with longer follow-up may be needed for confirmation.