J Korean Med Sci.
2019 Aug;34(33):e223. 10.3346/jkms.2019.34.e223.
The New Cutoff Value of the Hepatic Venous Pressure Gradient on Predicting Long-Term Survival in Cirrhotic Patients
- Affiliations
-
- 1Department of Internal Medicine, New Hope Internal Medicine Clinic, Seoul, Korea.
- 2Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea.
- 3Department of Internal Medicine, Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea. jyjang@schmc.ac.kr
- 4Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, Korea. drkimmy@yonsei.ac.kr
- 5Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea.
- 6Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
- 7Institute of Lifestyle Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
- KMID: 2455487
- DOI: http://doi.org/10.3346/jkms.2019.34.e223
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
- Full Text Links
-
- Actions
-
Cited
- CITED
-
- Close
- Share
-
- Similar articles
-
- Hepatic Venous Pressure Gradient Predicts Long-Term Mortality in Patients with Decompensated Cirrhosis
- Combined effect of hepatic venous pressure gradient and liver stiffness on long-term mortality in patients with cirrhosis
- The relation between hepatic venous pressure gradient and complications of liver cirrhosis
- Pharmacological Therapy of Portal Hypertension: Focused on Korean Data
- Sarcopenia as a Useful Predictor for Long-Term Mortality in Cirrhotic Patients with Ascites
