|
KMID : 0191120190340330223
|
|
Journal of Korean Medical Science
2019 Volume.34 No. 33 p.223 ~ p.223
|
|
|
The New Cutoff Value of the Hepatic Venous Pressure Gradient on Predicting Long-Term Survival in Cirrhotic Patients
|
|
Kim Tae-Yeob
Suk Ki-Tae
Jeong Soung-Won
Ryu Tom
Kim Dong-Joon
Baik Soon-Koo
Sohn Joo-Hyun
Jeong Woo-Kyoung
Choi Eun-Hee
Jang Jae-Young
Kim Moon-Young
|
|
|
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.
|
|
|
KEYWORD
|
|
|
Cirrhosis, Hemodynamics, Portal Hypertension, Prognosis
|
|
|
FullTexts / Linksout information
|
|
 
|
|
|
Listed journal information
|
|
    
|
|