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Porto-sinusoidal vascular disorder in chronic HBV: A significant coexistence not to be overlooked
Pol Olivas1,2, Valeria Perez-Campuzano1,2, Lara Orts1,2
1Liver Unit, Hospital Clínic, Fundació Recerca Clínic Barcelona- Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). Departament de Medicina i Ciències de la Salut. Universitat de Barcelona. Centro de Investigación biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.
Insights
Chronic hepatitis B (CHB) is more prevalent in porto-sinusoidal vascular disorder (PSVD) patients, leading to delayed diagnosis and worse outcomes. Early recognition of this coexistence is crucial for improved PSVD patient management.
Area of Science:
- Hepatology
- Vascular Liver Diseases
- Viral Hepatitis
Background:
- Porto-sinusoidal vascular disorder (PSVD) is characterized by vascular abnormalities causing portal hypertension without cirrhosis.
- Current diagnostic criteria permit co-occurrence with other liver diseases, but the relationship with chronic hepatitis B (CHB) is not well understood.
Purpose of the Study:
- To determine the prevalence of hepatitis B virus (HBV) infection in patients with PSVD.
- To evaluate the clinical impact of coexisting CHB on PSVD diagnosis and outcomes.
Main Methods:
- Retrospective analysis of 155 PSVD patients at Hospital Clínic Barcelona.
- Assessment of HBV serology to categorize patients into chronic infection, past infection, or no HBV exposure.
- Comparison of clinical characteristics and outcomes between PSVD patients with and without CHB.
Main Results:
- Prevalence of CHB (5.8%) and past HBV infection (20%) was significantly higher in PSVD patients than the general population.
- Patients with CHB experienced a significant delay in PSVD diagnosis (11 years vs. 1 year) and presented with more advanced disease (MELD score 12 vs. 9).
- PSVD patients with CHB had a substantially higher liver transplantation rate (33% vs. 4.1%).
Conclusions:
- Coexistence of PSVD and CHB is more common than previously thought.
- CHB significantly impacts PSVD diagnosis and clinical course, leading to poorer outcomes.
- Timely diagnosis and management strategies are essential for PSVD patients with CHB.
Background & Aims:
Porto-sinusoidal vascular disorder (PSVD) encompasses a group of liver diseases with vascular abnormalities that can cause portal hypertension in the absence of cirrhosis. The new diagnostic criteria allow for coexistence with other liver diseases, however its relationship with chronic hepatitis B (CHB) remains unclear. This study aimed to assess HBV prevalence in a PSVD cohort and evaluate its clinical impact.
Methods:
This retrospective study was conducted on patients with PSVD at Hospital Clínic Barcelona. HBV serology was evaluated, and patients were categorized into HBV chronic infection, past infection, or no HBV exposure. Clinical characteristics and outcomes were compared.
Results:
We included 155 patients with PSVD. Prevalence of CHB and past HBV infection in patients with PSVD was higher than in the general population (5.8% vs. 0.5%, p <0.0001 and 20% vs. 9.1%, p <0.0001, respectively). Patients with CHB had a significant delay in PSVD diagnosis compared to those without CHB (11 [5-25] vs. 1 [0-3] years, p = 0.002) and had a more advanced disease (MELD score 12 [9-17] vs. 9 [7-11], p = 0.012) at the time of PSVD diagnosis. The clinical evolution of PSVD in patients with CHB was marked by a significantly higher transplantation rate at the last follow-up (33% vs. 4.1%, p = 0.001).
Conclusions:
Recognizing the coexistence of PSVD and CHB is important for timely diagnosis and optimal management, highlighting the potential benefits of specialized care for potentially improved outcomes.
Impact And Implications:
The new diagnostic criteria for porto-sinusoidal vascular disorder (PSVD) allow for coexistence with other liver diseases. The results of the present study highlight, for the first time, a non-negligible prevalence of chronic hepatitis B in the PSVD population that was previously unknown. Coexistence may challenge and delay the PSVD diagnosis and is associated with a more unfavorable clinical course. Our findings will increase awareness of this coexistence and improve PSVD diagnosis and management. Furthermore, the data will encourage new studies to determine the prevalence and clinical behavior of other chronic liver diseases that coexist with PSVD.
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