Portal vein thrombosis and hyperhomocysteinemia in patients with liver cirrosis

Background: Portal vein thrombosis (PVT) is a severe complication of liver cirrhosis (LC), especially in presence of hepatocarcinoma (HCC). Liver is the main site of homocysteine (Hcy) metabolism and Hcy-related vitamins (folate, B12) storage. Aim: Assessment of possible association of moderate hyperhomocysteinemia (HHcy) (> 15 \uf06dmol/L), risk factor for deep venous thrombosis, and TVP in different stage LC patients, with and without HCC.Methods: 16 (aged 60\ub112, 8 f) LC patients with documented (doppler ultrasonography) PVT and 32 (aged 64\ub111, 12f) without PT were studied [total plasma Hcy (HPLC), Hcy-related vitamin status (ELISA), stage of disease (Child-Pugh score), presence of HCC (radiological and/or histological diagnosis), ethiology (alcohol, viral, both, other)]. Results: Hcy levels significantly (corrected for vitamin status) increases with Child-Pugh score (A: 11.84\ub14.2, n=12; B=16.5\ub18.2, n=22; C=18.5\ub18.1, n=14, \uf06dmol/L. p=0.021); HCC patients (n=18) showed higher Hcy than those without HCC (17.7\ub17.4vs.13.5\ub15.9,p=ns,after vitamin status correction). As expected, prevalence of HCC was higher in PVT group (10/16 (62.5%) vs. 8/32 (25%) ,p <0.01). TVP group presented lower serum folate (3.8\ub11.2 vs. 5.5\ub11.8 nmol/ml, p=0.017) and B12 levels (352\ub189 vs. 516\ub1125, p=.038), with no differences for different ethiologies, and a higher prevalence of folate and B12 deficit. After correction for vitamin status, Child-Pugh score, and prevalence of HCC, TVP group showed higher Hcy (19.7\ub15.5 vs. 13.81\ub17.8 \uf06dmol/L, p=0.015) and an higher prevalence of HHcy (10/16 (62.5%) vs 8/32 (25%), p<.011). Association of HHcy and TVP resulted significant (OR=5.0,95%CI:1.4-18.2, p=0.014). Conclusions: Our data suggest the possible importance of raised Hcy levels in development of TVP in cirrhotic patients, especially in higher stadium of disease or complicated by HCC. Studies about the role of treatment of HHcy in LC patients for the prevention of TVP are underway