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Portal Hypertension as a Complication of Cystic Echinococcosis: A 20-Year Cohort Analysis

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  • 1 Servicio de Medicina Interna, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain;
  • | 2 Servicio de Medicina Interna, Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca, Universidad de Salamanca, Salamanca, Spain;
  • | 3 Área de Medicina Preventiva y Salud Pública, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca, Universidad de Salamanca, Salamanca, Spain;
  • | 4 Servicio de Digestivo, Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain;
  • | 5 Servicio de Medicina Interna, Sección de Enfermedades Infecciosas, Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca, Salamanca, Spain;
  • | 6 Servicio de Dermatología, Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca, Salamanca, Spain;
  • | 7 Sección de Enfermedades Infecciosas, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain;
  • | 8 Servicio de Medicina Interna, Hospital Marqués de Valdecilla Instituto de Investigación Marqués de Valdecilla, Avenida Valdecilla SN, 39008 Santander, Spain;
  • | 9 Servicio de Medicina Interna, Sección de Enfermedades Infecciosas, Complejo Asistencial Universitario de Salamanca, Instituto de investigación Biomédica de Salamanca, Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca, Universidad de Salamanca, Paseo San Vicente 58-182, 37007, Salamanca, Spain

ABSTRACT.

Cystic echinococcosis (CE) is a parasitic disease caused by the larval forms of species of the tapeworm Echinococcus. The most common location is the liver. To assess the frequency and clinical characteristics of portal hypertension (PH) and the risk factors for PH development, we performed a retrospective observational study of inpatients diagnosed with hepatic CE and PH from January 1998 to December 2018, at Complejo Asistencial Universitario de Salamanca, Spain. Of 362 patients analyzed with hepatic CE, 15 inpatients (4.1%) had a portal vein diameter ≥ 14 mm, and the mean diameter of the portal vein was 16.9 (standard deviation [SD] ±2.1) mm. Twelve patients were men. The mean age was 59.5 years (SD ± 17.8 years). Four patients had ascites (26.6%), four had collateral circulation (26.6%), 14 had hepatosplenomegaly (93.3%), five had esophageal varices (33.3%), four had hematemesis, and three had jaundice. Other causes of PH included hepatitis B virus (1 patient) and hepatitis C virus (1 patient) infections and alcohol abuse (1 patient). The host variables associated with PH development were male sex (odds ratio, 4.6; 95% confidence interval, 1.1–20.9; P = 0.030) and larger cyst size (10.8 ± 6.3 versus 7.6 ± 4.1; P = 0.004). Hepatic CE is an infrequent cause of PH that usually occurs without indications of liver failure. Larger cyst size and male sex were the main risk factors associated with this complication. Mortality was higher for patients with hepatic CE with PH than for patients with hepatic CE without PH.

Author Notes

Address correspondence to Moncef Belhassen-García, Servicio de Medicina Interna. Sección de Enfermedades Infecciosas, Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca, Universidad de Salamanca, Paseo San Vicente 58-182, 37007, Salamanca, Spain. E-mail: mbelhassen@hotmail.com

Authors’ addresses: Javier Collado Aliaga, Servicio de Medicina Interna, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain, E-mail: humanoide123@hotmail.com. Ángela Romero-Alegría, Servicio de Medicina Interna, Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca, Universidad de Salamanca, Salamanca, Spain, E-mail: aralegria82@hotmail.com. Montserrat Alonso-Sardón, Área de Medicina Preventiva y Salud Pública, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca, Universidad de Salamanca, Salamanca, Spain, E-mail: sardonm@usal.es. Vanessa Prieto-Vicente, Servicio de Digestivo, Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain, E-mail: vanessapv_78@hotmail.com. Amparo López-Bernus, Servicio de Medicina Interna, Sección de Enfermedades Infecciosas, Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca, Salamanca, Spain, E-mail: albernus@hotmail.com. Virginia Velasco-Tirado, Servicio de Dermatología, Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca, Salamanca, Spain, E-mail: virvela@yahoo.es. Celia Sendra de la Ossa, Sección de Enfermedades Infecciosas, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain, E-mail: celiasendra@gmail.com. Javier Pardo-Lledias, Servicio de Medicina Interna, Hospital Marqués de Valdecilla Instituto de Investigación Marqués de Valdecilla, Avenida Valdecilla SN, 39008 Santander, Spain, E-mail: javipard2@hotmail.com. Moncef Belhassen-García, Servicio de Medicina Interna, Sección de Enfermedades Infecciosas, Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca, Universidad de Salamanca, Paseo San Vicente 58-182, 37007, Salamanca, Spain, E-mail: mbelhassen@hotmail.com.

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