Table_8_Epidemiology and Risk Factors of Portal Venous System Thrombosis in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis.docx

BackgroundPatients with inflammatory bowel disease (IBD) may be at risk of developing portal venous system thrombosis (PVST) with worse outcomes. This study aims to explore the prevalence, incidence, and risk factors of PVST among patients with IBD.MethodsPubMed, Embase, and Cochrane Library databases were searched. All the eligible studies were divided according to the history of colorectal surgery. Only the prevalence of PVST in patients with IBD was pooled if the history of colorectal surgery was unclear. The incidence of PVST in patients with IBD after colorectal surgery was pooled if the history of colorectal surgery was clear. Prevalence, incidence, and risk factors of PVST were pooled by only a random-effects model. Subgroup analyses were performed in patients undergoing imaging examinations. Odds ratios (ORs) with 95% CIs were calculated.ResultsA total of 36 studies with 143,659 patients with IBD were included. Among the studies where the history of colorectal surgery was unclear, the prevalence of PVST was 0.99, 1.45, and 0.40% in ulcerative colitis (UC), Crohn's disease (CD), and unclassified IBD, respectively. Among the studies where all the patients underwent colorectal surgery, the incidence of PVST was 6.95, 2.55, and 3.95% in UC, CD, and unclassified IBD after colorectal surgery, respectively. Both the prevalence and incidence of PVST became higher in patients with IBD undergoing imaging examinations. Preoperative corticosteroids therapy (OR = 3.112, 95% CI: 1.017–9.525; p = 0.047) and urgent surgery (OR = 1.799, 95% CI: 1.079–2.998; p = 0.024) are significant risk factors of PVST in patients with IBD after colorectal surgery. The mortality of patients with IBD with PVST after colorectal surgery was 4.31% (34/789).ConclusionPVST is not rare, but potentially lethal in patients with IBD after colorectal surgery. More severe IBD, indicated by preoperative corticosteroids and urgent surgery, is associated with a higher risk of PVST after colorectal surgery. Therefore, screening for PVST by imaging examinations and antithrombotic prophylaxis in high-risk patients should be actively considered.Systematic Review RegistrationRegistered on PROSPERO, Identifier: CRD42020159579.

背景：患有炎症性肠病（IBD）的患者可能存在发生门静脉系统血栓形成（PVST）的风险，且预后较差。本研究旨在探讨IBD患者中PVST的患病率、发病率和风险因素。方法：检索PubMed、Embase和Cochrane图书馆数据库。所有合格的研究根据结直肠癌手术史进行分类。若结直肠癌手术史不明确，则仅对IBD患者中PVST的患病率进行汇总。若结直肠癌手术史明确，则对IBD患者术后PVST的发病率进行汇总。仅使用随机效应模型汇总PVST的患病率、发病率和风险因素。在行影像学检查的患者中进行亚组分析。计算了95%置信区间（CI）的比值比（OR）。结果：共纳入36项研究，涉及143,659名IBD患者。在结直肠癌手术史不明确的研究中，溃疡性结肠炎（UC）、克罗恩病（CD）和无分类IBD的PVST患病率分别为0.99%、1.45%和0.40%。在所有患者均接受结直肠癌手术的研究中，UC、CD和无分类IBD术后PVST的发病率分别为6.95%、2.55%和3.95%。接受影像学检查的IBD患者中，PVST的患病率和发病率均有所升高。对于结直肠癌术后IBD患者，术前皮质类固醇治疗（OR = 3.112，95% CI: 1.017–9.525；p = 0.047）和紧急手术（OR = 1.799，95% CI: 1.079–2.998；p = 0.024）是PVST的显著风险因素。结直肠癌术后PVST患者的死亡率约为4.31%（34/789）。结论：PVST在结直肠癌术后IBD患者中并非罕见，且具有潜在致命性。更严重的IBD，如术前皮质类固醇治疗和紧急手术，与结直肠癌术后PVST的高风险相关。因此，应积极考虑对高风险患者进行影像学检查以筛查PVST，并实施抗凝预防措施。系统评价注册：已在PROSPERO注册，标识符：CRD42020159579。