PhD Scientific Days 2023

Translational Medicine I.

Time Dependency and Risk Factors of Splanchnic Vein Thrombosis Development in the Early Phase of Acute Pancreatitis: A Systematic Review and Meta-analysis

Text of the abstract

Introduction: Splanchnic vein thrombosis (SVT) is a well-known complication of acute pancreatitis (AP). Early detection and treatment are crucial for improving patient outcomes. However, information regarding risk factors and time course in the early phase of AP is scarce.
Aim: Our objective was to collect and investigate data on the time course of SVT and its risk factors in the early phase of AP, with the intention of conducting a systematic review and meta-analysis.
Method: A systematic search was performed across four medical databases (Embase, PubMed, Scopus, Cochrane). Inclusion criteria consisted of appropriate imaging in adult AP patients and reliable reporting of imaging timing. Exclusion criteria included recent history of malignancy and surgical interventions. Pooled proportions of patients affected by SVT were calculated with 95% confidence intervals (CI), and subgroup analyses were conducted for diagnostic timing and disease characteristics. The Joanna Briggs Institute Critical Appraisal tool was utilized for risk of bias assessment, and the GRADEpro tool for evaluating the level of evidence. The method protocol was prospectively registered in the PROSPERO database, CRD42022367578.
Results: Data from 15 eligible studies and 1,979 patients was pooled; the proportion of patients with SVT during the early phase of AP (within 11 days post-symptom onset/5 days post-admission) was 0.16 (CI 0.08-0.29). The incidence was lowest at 0-3 days post-symptom onset (0.05, CI 0.00-0.45) and increased nearly five-fold to 0.23 (CI 0.02-0.79) between 3-11 days. Disease factors influencing SVT occurrence included severity (mild 0.14 (CI 0.04-0.39), moderate 0.23 (CI 0.09-0.47), severe 0.31 (CI 0.15-0.54), p=0.21), etiology (alcoholic 0.31 (CI 0.13-0.58), biliary 0.12 (CI 0.04-0.3), p=0.03), and pancreatic necrosis (absent 0.11 (CI 0.05-0.25), <30% 0.25 (CI 0.11-0.47), >30% 0.5 (CI 0.29-0.72), p=0.01).
Conclusion: One in six patients develops SVT during the early phase of AP. Increased risk is associated with a severe disease course, alcoholic etiology, and pancreatic necrosis. Moreover, this risk appears to increase with AP duration; hence, employing imaging to look for and diagnose SVT is vital in AP management.
Funding: The Centre for Translational Medicine at Semmelweis University provided funding through the PhD program. Sponsors were not involved in the project.