Predictors of myeloproliferative neoplasm in non-cirrhotic portal vein thrombosis: a comparative analysis with hereditary thrombophilia-related cases

Abstract

Objective: Non-cirrhotic portal vein thrombosis (PVT) is rare in patients without cirrhosis or intra-abdominal malignancy, commonly associated with thrombophilia or myeloproliferative neoplasms (MPNs). Comparative studies on clinical and laboratory features of MPN- versus thrombophilia-related PVT are limited. This study aimed to examine etiological differences and identify parameters that may aid differential diagnosis.

Materials and Methods: In this retrospective cross-sectional study, 73 adult patients with non-cirrhotic PVT due to MPNs or hereditary thrombophilia were included. Clinical, laboratory, imaging, and endoscopic data were collected from records. Continuous variables were analyzed using t-test or Mann-Whitney U test, and categorical variables using chi-square or Fisher’s exact test. Multivariable logistic regression and ROC analysis identified predictors of MPN-associated PVT.

Results: Platelet counts were significantly higher in the MPN group than in the thrombophilia group (p<0.001). Hepatomegaly and portal double ductopathy (PDD) were more frequent in MPN, with the difference for PDD being significant (p=0.032). Splenic/superior mesenteric vein involvement occurred in 41.7% versus 26.5%, and portal vein cavernous transformation (PVCT) in 79.2% versus 57.1%; these differences were not statistically significant. In multivariable analysis, platelet count was the only independent predictor of MPN (p=0.003). ROC analysis showed an AUC of 0.79, with a cutoff ≥161×10³/µL yielding 85% sensitivity and 61% specificity.

Conclusion: Platelet count is a strong, independent marker for distinguishing MPN-related non-cirrhotic PVT. Although PDD and PVCT are more frequent in MPN, platelet level offers a rapid, practical parameter for differential diagnosis. These findings provide valuable guidance for clinical practice and patient selection for advanced genetic testing.