Spontaneous portosystemic shunt as a potiential marker for severe liver damage and high risk of complications associated with portal hypertension in patients with hepatitis B-related cirrhosis: a multicenter study from China

AbstractBackground and aim Patients with cirrhosis have a high prevalence of spontaneous portosystemic shunt (SPSS), but it remains controversial whether the presence of SPSS is associated with liver function and portal hypertension (PHT)-related complications. In this study, we aimed to investigate the prevalence, clinical characteristics and related factors of SPSS in cirrhotic patients. Methods Patients who were diagnosed with hepatitis B-related cirrhosis between Jan 2020 and Oct 2021 were retrospectively recruited from five centers in China. All eligible patients were classified into SPSS and non-SPSS groups and their clinical characteristics were compared. Logistic regression analyses were performed to identify clinical characteristics associated with SPSS, and then to assess the independent impact of SPSS on the risk of PHT-related complications. Results Of the 1282 patients included in this study, SPSS was identified in 488 patients (38.1%). SPSS group had a higher proportion of patients with hepatofugal flow in portal vein, thinner diameter of right branch of portal vein (RPV), thicker diameter of left branch of portal vein (LPV), splenic vein (SV) and superior mesenteric vein (SMV), more severe liver function impairment, higher incidence and severity of esophageal and gastric varices (EGV), and a higher prevalence of PHT-related complications [EGV bleeding (EGVB), portal vein thrombosis (PVT), hepatic encephalopathy (HE), ascites, and hepatocellular carcinoma (HCC)] (allP < 0.05). On multivariable logistic regression analyses, MELD score, diameter of RPV and SV, hepatofugal flow in portal vein, EV or GV or EGV on radiological evaluation, presence of EGVB, PVT, HE, and moderate–severe ascites were independently associated with SPSS (allP < 0.05). In addition, presence of SPSS was identified as an independent risk factor for EGVB, PVT and HE (allP < 0.05). Conclusion SPSS may indicate severe liver damage and a high risk of PHT-related complications.