The New Cutoff Value of the Hepatic Venous Pressure Gradient on Predicting Long-Term Survival in Cirrhotic Patients
10.3346/jkms.2019.34.e223
- Author:
Tae Yeob KIM
1
;
Ki Tae SUK
;
Soung Won JEONG
;
Tom RYU
;
Dong Joon KIM
;
Soon Koo BAIK
;
Joo Hyun SOHN
;
Woo Kyoung JEONG
;
Eunhee CHOI
;
Jae Young JANG
;
Moon Young KIM
Author Information
1. Department of Internal Medicine, New Hope Internal Medicine Clinic, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Cirrhosis;
Hemodynamics;
Portal Hypertension;
Prognosis
- MeSH:
Discrimination (Psychology);
Fibrosis;
Follow-Up Studies;
Hemodynamics;
Humans;
Hypertension, Portal;
Hypoalbuminemia;
Liver Diseases;
Mortality;
Multivariate Analysis;
Prognosis;
Retrospective Studies;
Venous Pressure
- From:Journal of Korean Medical Science
2019;34(33):e223-
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: This study aimed to determine the prognostic role of the categorized hemodynamic stage (HS) based on the hepatic venous pressure gradient (HVPG) in patients with portal hypertension. METHODS: Of 1,025 cirrhotic patients who underwent HVPG measurement, data on 572 non-critically-ill patients were collected retrospectively between 2008 and 2013. The following two HS categorizations were used: HS-1 (6–9, 10–12, 13–16, 17–20, and > 20 mmHg; designated as groups 1–5, respectively) and HS-2 (6–12, 13–20, and > 20 mmHg). Clinical characteristics, mortality rates, and prognostic predictors were analyzed according to the categorized HS. RESULTS: During the mean follow-up period of 25 months, 86 (15.0%) patients died. The numbers of deaths in HS-1 groups were 7 (6.3%), 7 (6.9%), 30 (18.0%), 20 (15.6%), and 22 (34.4%), respectively (P < 0.001). However, the traditional HVPG cutoffs of 10 and 16 mmHg did not improve the discrimination of mortality. In contrast, the mortality rates did differ significantly between the three HS-2 groups (P < 0.05). In the multivariate analysis, all models revealed that HS-2 was a common prognostic factor in predicting mortality. The mortality rates increased significantly according to HS-2 in patients with hypoalbuminemia (HVPG, 13–20 mmHg; hazard ratio [HR], 2.54 and HVPG > 20 mmHg; HR, 5.45) and intermediate model for end-stage liver disease (MELD) score (HVPG, 13–20 mmHg; HR, 3.86 and HVPG > 20 mmHg; HR, 8.77; P < 0.05). CONCLUSION: Categorizing HVPG values according to HS-2 is a useful prognostic modality in patients with portal hypertension and can play an independent role in predicting the prognosis in patients with hypoalbuminemia and an intermediate MELD score.
