Korean J Hepatol.  2009 Sep;15(3):350-356. 10.3350/kjhep.2009.15.3.350.

Comparison of the Model for End-stage Liver Disease and hepatic venous pressure gradient for predicting survival in patients with decompensated liver cirrhosis

• Lee SH
• Park SH
• Kim GW
• Lee WJ
• Hong WK
• Ryu MS
• Park KT
• Lee MY
• Lee CW
• Kim JH
• Kim YM
• Kim SJ
• Baik GH
• Kim JB
• Kim DJ

• KMID: 1374963
• DOI: http://doi.org/10.3350/kjhep.2009.15.3.350

Abstract

BACKGROUND/AIMS: This study compared the prognostic values of the Model for End-stage Liver Disease (MELD) and the hepatic venous pressure gradient (HVPG) in the prediction of death within 3 and 12 months in patients with decompensated liver cirrhosis.
METHODS
We used data from 136 consecutive patients with decompensated cirrhosis who underwent HVPG between January 2006 and June 2008. Cox regression analysis was used to investigate the independent relationships with death of MELD and HVPG. The prognostic accuracies of MELD and HVPG were analyzed by calculating the area under the receiver operating characteristic curve (AUROC) for the occurrence of death within 3 and 12 months.
RESULTS
Both MELD and HVPG were independent predictors of death [hazard ratio (HR)=1.11 and 1.12, respectively; 95% confidence interval (CI)=1.04~1.20 and 1.08-1.16]. Analysis of the AUROC demonstrated that the prognostic power did not differ between MELD and HVPG for predicting the 3-month survival (HR=0.76 and 0.68, respectively; 95% CI=0.62~0.89 and 0.52~0.84; P=0.22) or the 12-month survival (HR=0.72 and 0.73, 95% CI=0.61~0.83 and CI=0.61~0.84).
CONCLUSIONS
Both MELD and HVPG are independent prognostic factors of death within 3 and 12 months in patients with decompensated liver cirrhosis, and their accuracies are similar. However, HVPG has a limited role in the prediction of death in decompensated cirrhosis due to its invasiveness and limited use.

Keyword

Decompensated; Cirrhosis; Model for End-stage Liver Disease; Hepatic Venous Pressure Gradient; Prognosis

MeSH Terms

Adult
Aged
Area Under Curve
Cohort Studies
Female
Hepatic Veins/*physiopathology
Humans
Liver Cirrhosis/diagnosis/*mortality/physiopathology
Liver Failure/diagnosis/*mortality/physiopathology
Male
Middle Aged
Models, Biological
Predictive Value of Tests
Prognosis
Proportional Hazards Models
Regression Analysis
Retrospective Studies
Severity of Illness Index
Survival Analysis
Venous Pressure