Table_9_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的流行病学、发病率和危险因素。方法：检索PubMed、Embase和Cochrane图书馆数据库。所有符合条件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，则对结直肠癌手术后IBD患者中PVST的发病率进行汇总。仅采用随机效应模型汇总PVST的患病率、发病率和危险因素。对接受影像学检查的患者进行亚组分析。计算了具有95%置信区间的优势比（OR）。结果：共纳入36项研究，涉及143,659例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在结直肠癌手术后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较高。结直肠癌手术后，IBD患者中PVST的死亡率（34/789）为4.31%。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的显著危险因素。结论：PVST在结直肠癌手术后IBD患者中并不罕见，但具有潜在致命性。术前皮质类固醇和紧急手术等更严重的IBD症状与结直肠癌手术后PVST的高风险相关。因此，对于高风险患者，应积极考虑通过影像学检查筛查PVST以及进行抗凝预防。系统综述注册：已在PROSPERO注册，标识符：CRD42020159579。