Comparison of hepatic venous pressure gradient and two models of end-stage liver disease for predicting the survival in patients with decompensated liver cirrhosis.
OBJECTIVE
We evaluated the efficacy of initial and follow-up hepatic venous pressure gradient (HVPG), models of end-stage liver disease (MELD), and MELD-Na for predicting the survival of patients with decompensated liver cirrhosis (LC).


BACKGROUND
MELD with/without Na score and HVPG have been important predictors of mortality in patients with LC.


METHODS
Between January 2006 and 2011, a total of 57 patients with decompensated LC, all of whom underwent >2 HVPG measurements for the confirmation of propranolol dosing, were enrolled. MELD and MELD-Na scores were calculated on the day of HVPG measurement. The prognostic accuracy of the initial and follow-up HVPG, MELD, and MELD-Na were analyzed, and independent factors for mortality were evaluated.


RESULTS
Ten patients (17.5%) died from LC. Initial HVPG (0.883), initial MELD-Na (0.877), follow-up HVPG (0.829), and follow-up MELD-Na (0.802) showed good area under the receiver operating characteristic curve scores in predicting 1-year mortality. In predicting 2-year mortality, only follow-up HVPG (0.821, cut-off value 18 mm Hg) showed good score. Overall area under the receiver operating characteristic curves (initial and follow-up) were 0.843 and 0.864 in HVPG, 0.721 and 0.674 in MELD, and 0.762 and 0.715 in MELD-Na, respectively. In the Cox regression analysis, only follow-up HVPG (P=0.02; odds ratio, 1.11) was associated with mortality.


CONCLUSIONS
The efficacy of HVPG for predicting mortality is excellent compared with that of MELD or MELD-Na. Therefore, aside from the confirmation of adequate propranolol dosing, HVPG may be needed for predicting the survival of patients with decompensated LC.
Department of Internal Medicine #Molecular Medicine, Hallym University College of Medicine, Chuncheon, South Korea.
Ki Tae
KT
Suk
Chang Hoon
CH
Kim
Seung Ha
SH
Park
Ho Taik
HT
Sung
Jong Young
JY
Choi
Kwang Hyub
KH
Han
So Hyung
SH
Hong
Dae Yong
DY
Kim
Jai Hoon
JH
Yoon
Yeon Soo
YS
Kim
Gwang Ho
GH
Baik
Jin Bong
JB
Kim
Dong Joon
DJ
Kim
D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D019540:Area Under Curve; D001795:Blood Pressure Determination; D058625:End Stage Liver Disease / Q000097:blood / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006503:Hepatic Veins / Q000503:physiopathology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011433:Propranolol / Q000627:therapeutic use; D012372:ROC Curve; D018570:Risk Assessment; D012720:Severity of Illness Index; D012964:Sodium / Q000097:blood; D014690:Venous Pressure
D000959:Antihypertensive Agents; D012964:Sodium; D011433:Propranolol