The New Cutoff Value of the Hepatic Venous Pressure Gradient on Predicting Long-Term Survival in Cirrhotic Patientsopen access
- Authors
- Kim, Tae Yeob; Suk, Ki Tae; Jeong, Soung Won; Ryu, Tom; Kim, Dong Joon; Baik, Soon Koo; Sohn, Joo Hyun; Jeong, Woo Kyoung; Choi, Eunhee; Jang, Jae Young; Kim, Moon Young
- Issue Date
- Aug-2019
- Publisher
- 대한의학회
- Keywords
- Cirrhosis; Hemodynamics; Portal Hypertension; Prognosis
- Citation
- Journal of Korean Medical Science, v.34, no.33
- Indexed
- SCIE
SCOPUS
KCI
- Journal Title
- Journal of Korean Medical Science
- Volume
- 34
- Number
- 33
- URI
- https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/13288
- DOI
- 10.3346/jkms.2019.34.e223
- ISSN
- 1011-8934
- 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 noncritically-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.
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