title: Evaluation of paraumbilical vein as a prognostic index of severe liver cirrhotic patients with portal-systemic shunts.
abstract: OBJECTIVE
  The aim of this study was to predict the outcome in severe liver cirrhotic patients with portal-systemic shunts.
  
  
  METHODS
  One-hundred and sixteen patients with liver cirrhosis diagnosed as Child-Pugh class B and C with portal-systemic shunts confirmed by abdominal ultrasonography, computed tomography and magnetic resonance imaging were enrolled in this study. Twenty-three factors were evaluated concerning clinical laboratory parameters and extracted prognostic factors using the Cox proportional hazards model, and the prognostic index (PI) was prepared by combining these factors.
  
  
  RESULTS
  The cumulative survival rates after admission were 64.6%, 35.6% and 25% after 1, 3 and 5 years, respectively. Using multivariate analysis, age, the presence of hepatocellular carcinoma (HCC), portal vein tumor thrombosis (PVTT) and paraumbilical vein (PUV) shunt were selected as significant prognostic factors that contributed independently to the prognosis of severe liver cirrhotic patients with portal-systemic shunts. The PI was calculated with the following formula using these 4 factors. PI = 0.042 x Age + 0.913 x HCC + 0.989 x PVTT + 1.079 x PUV shunt. The group with a high score for PI was found to die with significantly higher frequency than the group with a low score.
  
  
  CONCLUSIONS
  It was found that tumor related factors and PUV shunt were the most important factors for severe liver cirrhotic patients with portal-systemic shunts. The PI is suggested to be an appropriate index to predict the prognosis for these patients.
authors.affiliation: Department of Pathophysiology, Showa University School of Pharmaceutical Sciences, Tokyo, Japan. mari-k@pharm.showa-u.ac.jp
authors.forename: M
authors.initials: M
authors.lastname: Kogo
authors.forename: Y
authors.initials: Y
authors.lastname: Nebashi
authors.forename: H
authors.initials: H
authors.lastname: Taniguchi
authors.forename: K
authors.initials: K
authors.lastname: Yoneyama
authors.forename: M
authors.initials: M
authors.lastname: Imawari
authors.forename: Y
authors.initials: Y
authors.lastname: Kiuchi
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications; D003097:Collateral Circulation; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000145:classification / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000401:mortality*; D008113:Liver Neoplasms / Q000150:complications; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011169:Portal Vein / Q000502:physiology / Q000503:physiopathology; D011170:Portasystemic Shunt, Surgical; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000150:complications