Giovannie Isaac-Coss, MD1, Meghana Kakarla, MD2, Zoe Post, MD, MSc1, Aryanna Sousa, MD, MPH3, Justin Mitchell, MD1, Joseph Frasca, MD1, Nancy Reau, MD, FACG1 1Rush University Medical Center, Chicago, IL; 2Infirmary Health, Mobile, AL; 3Rush University Medical Center, Providence, RI Introduction: Bowel ischemia is a severe but understudied complication of portal vein thrombosis, particularly in non-cirrhotic patients. While traditional thrombotic risk factors such as malignancy, inflammatory bowel disease, and hypercoagulability are presumed to increase risk, this assumption lacks population-level validation. This study aimed to identify clinical predictors of bowel ischemia and assess its impact on outcomes in non-cirrhotic PVT hospitalizations using a nationally representative dataset. Methods: We conducted a cross-sectional analysis of the 2018–2021 National Inpatient Sample to identify hospitalizations for non-cirrhotic PVT using ICD-10 codes. Patients with cirrhosis or chronic liver disease were excluded. Bowel ischemia was defined via validated ICD-10 codes. Multivariable logistic regression adjusted for demographics, clinical factors, and socioeconomic variables, including age, sex, sepsis, malignancy, IBD, hypercoagulable states, pancreatitis, and MPNs. Secondary outcomes were ICU care, mortality, LOS and hospitalization costs Results: Among 25,863 hospitalizations for non-cirrhotic PVT, bowel ischemia occurred in 2.3%. Sepsis was the strongest independent predictor (aOR 2.11; 95% CI: 1.75–2.55; p< 0.001), followed by older age (aOR 1.007 per year; 95% CI: 1.001–1.014; p=0.026) and female sex (aOR 1.21; 95% CI: 1.03–1.43; p=0.02). In contrast, malignancy (aOR 0.44; 95% CI: 0.36–0.54) and pancreatitis (aOR 0.40; 95% CI: 0.29–0.55) were associated with significantly lower odds of ischemia (p< 0.001). IBD, MPNs, and hypercoagulable states were not significantly associated. Bowel ischemia independently predicted ICU care (aOR 2.22; 95% CI: 1.65–2.98), in-hospital mortality (aOR 2.23; 95% CI: 1.77–2.80), prolonged LOS (+2.63 days; p< 0.001), and increased hospitalization charges (+$82,442; 95% CI: $50,878–$114,006; p< 0.001). Discussion: Bowel ischemia in non-cirrhotic PVT is uncommon but associated with significantly worse outcomes, including a twofold increase in ICU admission and in-hospital mortality. Sepsis and age were consistent independent predictors. Surprisingly, malignancy and pancreatitis were inversely associated with ischemia, suggesting potential influences from differential coding, treatment pathways, or protective care factors. Traditional thrombotic risk profiles may not adequately capture ischemic risk in this population. These findings highlight the need for improved risk stratification and earlier recognition strategies to guide clinical decision-making.
Figure: Table 1: Predictors and Clinical Outcomes of Bowel Ischemia in Non-Cirrhotic Portal Vein Thrombosis: Multivariable analysis of 25,863 non-cirrhotic PVT hospitalizations (2018–2021 NIS) identified sepsis (aOR 2.11), older age, and female sex as significant predictors of bowel ischemia. Bowel ischemia was associated with markedly increased risk of ICU-level care (aOR 2.22), in-hospital mortality (aOR 2.23), longer length of stay (+2.63 days), and higher hospitalization costs (+$82,442).
Figure: Table 2: ICD-10 codes utilized
Disclosures: Giovannie Isaac-Coss indicated no relevant financial relationships. Meghana Kakarla indicated no relevant financial relationships. Zoe Post indicated no relevant financial relationships. Aryanna Sousa indicated no relevant financial relationships. Justin Mitchell indicated no relevant financial relationships. Joseph Frasca indicated no relevant financial relationships. Nancy Reau: AbbVie – Grant/Research Support. Arbutus – Advisor or Review Panel Member. Gilead – Advisory Committee/Board Member, Grant/Research Support. Salix – Advisory Committee/Board Member, Grant/Research Support. VIR – Advisory Committee/Board Member, Grant/Research Support.
Giovannie Isaac-Coss, MD1, Meghana Kakarla, MD2, Zoe Post, MD, MSc1, Aryanna Sousa, MD, MPH3, Justin Mitchell, MD1, Joseph Frasca, MD1, Nancy Reau, MD, FACG1. P5843 - Bowel Ischemia in Non-Cirrhotic Portal Vein Thrombosis: A Nationwide Analysis of Predictors and Outcomes, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
