Goals: 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.
Study: 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.
Departments of *Internal Medicine
#Molecular Medicine, Hallym University College of Medicine, Chuncheon
‡Department of Internal Medicine, Inje University College of Medicine, Busan
∥Department of Internal Medicine, Catholic University College of Medicine
¶Liver Cirrhosis Clinical Research Center, Yonsei University College of Medicine, Seoul, South Korea
†College of Medicine, Upstate Medical University, State University of New York, Syracuse, NY
§Department of Biology, Stanford University, Stanford, CA
Supported by a grant from the Ministry of Health and Welfare, Republic of Korea (No. A102065) and by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (2011-0026601).
Authors attest that there are no commercial associations that might be a conflict of interest in relation to the submitted manuscript.
Reprints: Dong Joon Kim, MD, Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Gyo-dong, Chuncheon 200-704, South Korea (e-mail: firstname.lastname@example.org).
Received December 26, 2011
Accepted May 11, 2012