Hepatic involvement and portal hypertension predict mortality in chronic granulomatous disease.
OBJECTIVE
Chronic granulomatous disease (CGD) is a rare genetic disorder, predisposing affected individuals to recurrent infectious complications and shortened survival. Liver involvement in CGD includes vascular abnormalities, which may lead to noncirrhotic portal hypertension.


METHODS
To evaluate the impact of noncirrhotic portal hypertension on survival in CGD, all records from 194 patients followed up at the National Institutes of Health with CGD were reviewed. Cox proportional hazards regression was used to determine factors associated with mortality.


RESULTS
Twenty-four patients died, all from infectious complications. By Cox regression, factors associated with mortality were as follows: (1) decreases in platelet count (>9000/microL/y; hazard ratio, 4.7; P = .007), (2) alkaline phosphatase level increases (>0.25/y; hazard ratio, 4.5; P = .01) and (3) history of liver abscess (hazard ratio, 3.1; P = .03). By regression analysis, decreasing platelet count was associated with increasing portal vein diameter, splenomegaly, increased serum immunoglobulin G level, and increasing number of alanine aminotransferase increases; greater number of alkaline phosphatase level increases and abscess were both associated with increasing age and number of infections. Prospective evaluation revealed increased hepatic-venous pressure gradients in 2 patients with progressive thrombocytopenia, suggestive of portal hypertension.


CONCLUSIONS
These data suggest mortality in patients with CGD is associated with the development of noncirrhotic portal hypertension, likely owing to injury to the microvasculature of the liver from repeated systemic and hepatic infections. The slope of decline in platelet count may be a useful measure of progression of portal hypertension over time. Furthermore, the data illustrate the potential independent effect of portal hypertension on clinical outcome outside the setting of cirrhosis.
Feld
Jordan J
JJ
Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland 20892-1800, USA.
Hussain
Nadeem
N
Wright
Elizabeth C
EC
Kleiner
David E
DE
Hoofnagle
Jay H
JH
Ahlawat
Sushil
S
Anderson
Victoria
V
Hilligoss
Dianne
D
Gallin
John I
JI
Liang
T Jake
TJ
Malech
Harry L
HL
Holland
Steven M
SM
Heller
Theo
T
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006105:Granulomatous Disease, Chronic / Q000097:blood / Q000150:complications / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D006975:Hypertension, Portal / Q000097:blood / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D008099:Liver / Q000098:blood supply*; D008107:Liver Diseases / Q000097:blood / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D008833:Microcirculation / Q000503:physiopathology; D008875:Middle Aged; D016017:Odds Ratio; D010976:Platelet Count; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors