title: Influence of hepatic venous pressure gradient on the prediction of survival of patients with cirrhosis in the MELD Era.
abstract: Measurements of portal pressure, usually obtained via the hepatic venous pressure gradient (HVPG) may be a prognostic marker in cirrhosis. The aim of this study was to evaluate the impact of HVPG on survival in patients with cirrhosis in addition to the Model for End-Stage Liver Disease (MELD) score. We also examined whether inclusion of HVPG in a model with MELD variables improves its prognostic ability. Retrospective analyses of all patients who had HVPG measurements between January 1998 and December 2002 were considered. Proportional hazards Cox models were developed. Prognostic calibrative and discriminative ability of the model was evaluated. In this period, 693 patients had a hepatic hemodynamic study, and 393 patients were included. Survival was significantly worse in those patients with greater HVPG value (univariate HR, 1.05; 95% CI, 1.02-1.08; P = .001). HVPG remained as an independent variable in a model adjusted by MELD, ascites, encephalopathy, and age (multivariate HR, 1.03; 95% CI, 1.00-1.06; P = .05) so that each 1-mmHg increase in HVPG had a 3% increase in death risk. In addition, HVPG as well as MELD score variables and age, significantly contributes to the calibrative predictive capacity of the prognostic model; however, discriminative ability improved only slightly (overall C statistic [95% CI]; MELD score variables: 0.71 [0.62-0.80], MELD score variables, age, and HVPG 0.76: [0.69-0.83]). In conclusion, HVPG has an independent effect on survival in addition to the MELD score. Although inclusion of HVPG and age in a survival predicting model would improve the calibrative ability of MELD, its discriminative ability is not significantly improved.
authors.affiliation: Sección de Hepatología, Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Ripoll
authors.forename: Rafael
authors.initials: R
authors.lastname: Bañares
authors.forename: Diego
authors.initials: D
authors.lastname: Rincón
authors.forename: María-Vega
authors.initials: MV
authors.lastname: Catalina
authors.forename: Oreste
authors.initials: O
authors.lastname: Lo Iacono
authors.forename: Magdalena
authors.initials: M
authors.lastname: Salcedo
authors.forename: Gerardo
authors.initials: G
authors.lastname: Clemente
authors.forename: Oscar
authors.initials: O
authors.lastname: Núñez
authors.forename: Ana
authors.initials: A
authors.lastname: Matilla
authors.forename: Luis-Miguel
authors.initials: LM
authors.lastname: Molinero
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006503:Hepatic Veins; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology*; D017093:Liver Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014690:Venous Pressure