[Comparison of the Model for End-stage Liver Disease and hepatic venous pressure gradient for predicting survival in patients with decompensated liver cirrhosis].
OBJECTIVE
This study compared the prognostic values of the Model for End-stage Liver Disease (MELD) and the hepatic venous pressure gradient (HVPG) in the prediction of death within 3 and 12 months in patients with decompensated liver cirrhosis.


METHODS
We used data from 136 consecutive patients with decompensated cirrhosis who underwent HVPG between January 2006 and June 2008. Cox regression analysis was used to investigate the independent relationships with death of MELD and HVPG. The prognostic accuracies of MELD and HVPG were analyzed by calculating the area under the receiver operating characteristic curve (AUROC) for the occurrence of death within 3 and 12 months.


RESULTS
Both MELD and HVPG were independent predictors of death [hazard ratio (HR)=1.11 and 1.12, respectively; 95% confidence interval (CI)=1.04~1.20 and 1.08-1.16]. Analysis of the AUROC demonstrated that the prognostic power did not differ between MELD and HVPG for predicting the 3-month survival (HR=0.76 and 0.68, respectively; 95% CI=0.62~0.89 and 0.52~0.84; P=0.22) or the 12-month survival (HR=0.72 and 0.73, 95% CI=0.61~0.83 and CI=0.61~0.84).


CONCLUSIONS
Both MELD and HVPG are independent prognostic factors of death within 3 and 12 months in patients with decompensated liver cirrhosis, and their accuracies are similar. However, HVPG has a limited role in the prediction of death in decompensated cirrhosis due to its invasiveness and limited use.
Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea.
Sung Hoa
SH
Lee
Seung Ha
SH
Park
Go Woon
GW
Kim
Woo Jin
WJ
Lee
Won Ki
WK
Hong
Myeong Shin
MS
Ryu
Kyu Tae
KT
Park
Min Young
MY
Lee
Chan Woo
CW
Lee
Jin Ho
JH
Kim
Yong Mook
YM
Kim
Sung Jung
SJ
Kim
Gwang Ho
GH
Baik
Jin Bong
JB
Kim
Dong Joon
DJ
Kim
D000328:Adult; D000368:Aged; D019540:Area Under Curve; D015331:Cohort Studies; D005260:Female; D006503:Hepatic Veins / Q000503:physiopathology*; 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; D008954:Models, Biological; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D014690:Venous Pressure