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Journal of Clinical Gastroenterology:
doi: 10.1097/MCG.0b013e31825f2622
LIVER, PANCREAS AND BILIARY TRACT: Original Articles

Comparison of Hepatic Venous Pressure Gradient and Two Models of End-stage Liver Disease for Predicting the Survival in Patients With Decompensated Liver Cirrhosis

Suk, Ki Tae MD*; Kim, Chang Hoon BS; Park, Seung Ha MD; Sung, Ho Taik BS§; Choi, Jong Young MD; Han, Kwang Hyub MD; Hong, So Hyung BS#; Kim, Dae Yong MD*; Yoon, Jai Hoon MD*; Kim, Yeon Soo MD*; Baik, Gwang Ho MD*; Kim, Jin Bong MD*; Kim, Dong Joon MD*

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Abstract

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.

© 2012 Lippincott Williams & Wilkins, Inc.

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