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

• Published in: Journal of Korean medical science 2019, 34(33), , pp.1-14
• Main 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
• Format: Article
• Language: English
• Subjects: Adult; Aged; Female; Hemodynamics; Hepatic Veins - physiopathology; Humans; Hypertension, Portal - complications; Hypertension, Portal - diagnosis; Hypertension, Portal - pathology; Hypoalbuminemia - diagnosis; Liver Cirrhosis - complications; Liver Cirrhosis - mortality; Liver Cirrhosis - pathology; Male; Middle Aged; Original; Prognosis; Proportional Hazards Models; Retrospective Studies; Risk; Severity of Illness Index; Survival Rate; 의학일반
• ISSN: 1011-8934; 1598-6357
• DOI: 10.3346/jkms.2019.34.e223

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. 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. 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 ( < 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 ( < 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; < 0.05). 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.