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The New Cutoff Value of the Hepatic Venous Pressure Gradient on Predicting Long-Term Survival in Cirrhotic Patientsopen access

Authors
Kim, T.Y.[Kim, T.Y.]Suk, K.T.[Suk, K.T.]Jeong, S.W.[Jeong, S.W.]Ryu, T.[Ryu, T.]Kim, D.J.[Kim, D.J.]Baik, S.K.[Baik, S.K.]Sohn, J.H.[Sohn, J.H.]Jeong, W.K.[Jeong, W.K.]Choi, E.[Choi, E.]Jang, J.Y.[Jang, J.Y.]Kim, M.Y.[Kim, M.Y.]
Issue Date
26-Aug-2019
Publisher
NLM (Medline)
Keywords
Cirrhosis; Hemodynamics; Portal Hypertension; Prognosis
Citation
Journal of Korean medical science, v.34, no.33, pp.e223
Indexed
SCIE
SCOPUS
KCI
Journal Title
Journal of Korean medical science
Volume
34
Number
33
Start Page
e223
URI
https://scholarworks.bwise.kr/skku/handle/2021.sw.skku/14580
DOI
10.3346/jkms.2019.34.e223
ISSN
1598-6357
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. © 2019 The Korean Academy of Medical Sciences.
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