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The New Cutoff Value of the Hepatic Venous Pressure Gradient on Predicting Long-Term Survival in Cirrhotic Patients.

Authors
  • Kim, Tae Yeob1
  • Suk, Ki Tae2
  • Jeong, Soung Won3
  • Ryu, Tom3
  • Kim, Dong Joon2
  • Baik, Soon Koo4
  • Sohn, Joo Hyun5
  • Jeong, Woo Kyoung6
  • Choi, Eunhee7
  • Jang, Jae Young8
  • Kim, Moon Young9
  • 1 Department of Internal Medicine, New Hope Internal Medicine Clinic, Seoul, Korea. , (North Korea)
  • 2 Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea. , (North Korea)
  • 3 Department of Internal Medicine, Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea. , (North Korea)
  • 4 Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, Korea. , (North Korea)
  • 5 Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea. , (North Korea)
  • 6 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. , (North Korea)
  • 7 Institute of Lifestyle Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea. , (North Korea)
  • 8 Department of Internal Medicine, Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea. [email protected] , (North Korea)
  • 9 Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, Korea. [email protected] , (North Korea)
Type
Published Article
Journal
Journal of Korean medical science
Publication Date
Aug 26, 2019
Volume
34
Issue
33
Identifiers
DOI: 10.3346/jkms.2019.34.e223
PMID: 31436052
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

This study aimed to determine the prognostic role of the categorized hemodynamic stage (HS) based on the hepatic venous pressure gradient (HVPG) in patients with portal hypertension. Of 1,025 cirrhotic patients who underwent HVPG measurement, data on 572 non-critically-ill patients were collected retrospectively between 2008 and 2013. The following two HS categorizations were used: HS-1 (6-9, 10-12, 13-16, 17-20, and > 20 mmHg; designated as groups 1-5, respectively) and HS-2 (6-12, 13-20, and > 20 mmHg). Clinical characteristics, mortality rates, and prognostic predictors were analyzed according to the categorized HS. During the mean follow-up period of 25 months, 86 (15.0%) patients died. The numbers of deaths in HS-1 groups were 7 (6.3%), 7 (6.9%), 30 (18.0%), 20 (15.6%), and 22 (34.4%), respectively (P < 0.001). However, the traditional HVPG cutoffs of 10 and 16 mmHg did not improve the discrimination of mortality. In contrast, the mortality rates did differ significantly between the three HS-2 groups (P < 0.05). In the multivariate analysis, all models revealed that HS-2 was a common prognostic factor in predicting mortality. The mortality rates increased significantly according to HS-2 in patients with hypoalbuminemia (HVPG, 13-20 mmHg; hazard ratio [HR], 2.54 and HVPG > 20 mmHg; HR, 5.45) and intermediate model for end-stage liver disease (MELD) score (HVPG, 13-20 mmHg; HR, 3.86 and HVPG > 20 mmHg; HR, 8.77; P < 0.05). Categorizing HVPG values according to HS-2 is a useful prognostic modality in patients with portal hypertension and can play an independent role in predicting the prognosis in patients with hypoalbuminemia and an intermediate MELD score. © 2019 The Korean Academy of Medical Sciences.

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