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 PRO-LIVER study (n=753), were followed-up for two years to assess the risk of PVT, that was diagnosed by Doppler ultrasonography. Child-Pugh classes, MELD score, presence of hepatocellular carcinoma (HCC) and laboratory variables including SA, D-dimer and 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, HCC 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=0.005). A multivariate COX regression analysis showed that male sex, lower platelet count, and serum albumin ≤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 experiencing PVT compared to those with SA >35 g/L and could be considered as potential candidates to anticoagulant prophylaxis for PVT prevention.