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Extrahepatic conditions increase complication risk in portal hypertension

Patients with idiopathic noncirrhotic portal hypertension had a high risk for major surgical and portal hypertension-related complications if they also had extrahepatic conditions related to their disease, a history of ascites, or increased serum creatinine.

In the study published in Hepatology, Laure Elkrief, MD, from the Geneva University Hospitals in Switzerland, and colleagues focused on the morbidity and mortality outcomes of patients with idiopathic noncirrhotic portal hypertension (INCPH) who underwent abdominal surgery.

“Idiopathic noncirrhotic portal hypertension (INCPH) is a heterogeneous group of rare diseases causing portal hypertension and characterized by the absence of cirrhotic modification of the liver parenchyma and the patency of portal and hepatic veins,” they wrote. “Patients with INCPH may develop portal hypertension related complications, but usually have preserved liver function.”

Of the 44 patients who underwent surgical intervention, 25 had at least one extrahepatic condition associated with INCPH including either immunological disorders or HIV. Fourteen patients had two or more conditions.

Sixty-one postoperative complications occurred in 31 patients within 1 month after surgery. Twenty-seven portal hypertension-related complications occurred in 16 patients within 3 months after surgery including 12 patients who experienced decompensation of ascites.

A history of extrahepatic conditions (HR = 3.973; 95% CI, 1.129-13.982) and ascites (HR = 3.144; 95% CI, 1.162-8.504) correlated with at least one portal hypertension-related complication within 3 months after surgery.

Among the four patients who died within 6 months after surgery, serum creatinine of 100 mol/L or higher correlated with a 6-month cumulative mortality risk compared with lower levels (33% vs. 0%; HR = 1.007; 95% CI, 1.003-1.012)

The researchers deemed postoperative outcome as unfavorable in 50% of the cohort. Postoperative unfavorable outcomes were more common among those with two or more features including extrahepatic conditions or history of ascites at surgery compared with those without such features (64% vs. 5%).

“These simple features could be helpful in making a decision for abdominal surgery with due information of the patient on the risks of the intervention,” Elkrief and colleagues concluded. – by Talitha Bennett

Disclosure: Healio Gastroenterology and Liver Disease was unable to determine relevant financial disclosures at the time of publication.