Clinicopathological forms and prognostic index in Budd-Chiari syndrome.
BACKGROUND
A recent study in patients with Budd-Chiari syndrome showed the value of a prognostic index including age, Pugh score, ascites and serum creatinine. Surgical portosystemic shunt did not appear to improve survival.


OBJECTIVE
To validate these findings in an independent sample; to evaluate a classification into three forms according to the presence of features of acute injury, chronic lesions, or both of them (types I, II or III, respectively); and to assess whether taking into account this classification would alter our previous conclusions.


METHODS
Multivariate Cox model survival analysis, first on 69 new patients; second, on these 69 and 54 previous patients, all diagnosed since 1985.


RESULTS
Previous prognostic index had a significant prognostic value (P<0.0001) which was further improved by taking into account type III form (P<0.001). Type III form was associated with the poorest outcome. No significant impact of surgical shunting on survival was disclosed.


CONCLUSIONS
The prognosis of Budd-Chiari syndrome can be based on age, Pugh score, ascites, serum creatinine and the presence of features indicating acute injury superimposed on chronic lesions (type III form). The idea that surgical shunting has no significant impact on survival is reinforced by these findings.
Langlet
Philippe
P
Service d'Hépatologie, Hôpital Beaujon, Clichy, France.
Escolano
Sylvie
S
Valla
Dominique
D
Coste-Zeitoun
Delphine
D
Denie
Cecile
C
Mallet
Alain
A
Levy
Victor-Georges
VG
Franco
Dominique
D
Vinel
Jean-Pierre
JP
Belghiti
Jacques
J
Lebrec
Didier
D
Hay
Jean-Marie
JM
Zeitoun
Guy
G
D000293:Adolescent; D000328:Adult; D006502:Budd-Chiari Syndrome / Q000473:pathology* / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D011170:Portasystemic Shunt, Surgical; D011379:Prognosis; D016016:Proportional Hazards Models; D016019:Survival Analysis