Application of Hepatic Venous Pressure Gradient to Predict Prognosis in Cirrhotic Patients with a Low Model for End-stage Liver Disease Score
Background/aim: We aimed to derive a model representing the dynamic status of cirrhosis and to discriminate patients with poor prognosis even if the Model for End-Stage Liver Disease (MELD) score is low. Methods: This study retrospectively enrolled 700 cirrhotic patients with a MELD score of less th...
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| Format: | Article |
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MDPI AG
2020-10-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/10/10/805 |
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| author | Young Chang Ki Tae Suk Soung Won Jeong Jeong-Ju Yoo Sang Gyune Kim Young Seok Kim Sae Hwan Lee Hong Soo Kim Seong Hee Kang Soon Koo Baik Dong Joon Kim Moon Young Kim Jae Young Jang |
| author_facet | Young Chang Ki Tae Suk Soung Won Jeong Jeong-Ju Yoo Sang Gyune Kim Young Seok Kim Sae Hwan Lee Hong Soo Kim Seong Hee Kang Soon Koo Baik Dong Joon Kim Moon Young Kim Jae Young Jang |
| author_sort | Young Chang |
| collection | DOAJ |
| description | Background/aim: We aimed to derive a model representing the dynamic status of cirrhosis and to discriminate patients with poor prognosis even if the Model for End-Stage Liver Disease (MELD) score is low. Methods: This study retrospectively enrolled 700 cirrhotic patients with a MELD score of less than 20 who underwent hepatic venous pressure gradient (HVPG) measurement. A model named H6C score (= HVPG + 6 × CTP score) to predict overall survival was derived and internal and external validations were conducted with the derivation and validation cohorts. Results: The H6C score using the HVPG was developed based on a multivariate Cox regression analysis. The H6C score showed a great predictive power for overall survival with a time-dependent AUC of 0.733, which was superior to that of a MELD of 0.602. In patients with viral etiology, the performance of the H6C score was much improved with a time-dependent AUC of 0.850 and was consistently superior to that of the MELD (0.748). Patients with an H6C score below 45 demonstrated an excellent overall survival with a 5-year survival rate of 91.5%. Whereas, patients with an H6C score above 64 showed a dismal prognosis with a 5-year survival rate of 51.1%. The performance of the H6C score was further verified to be excellent in the validation cohort. Conclusion: This new model using the HVPG provides an excellent predictive power in cirrhotic patients, especially with viral etiology. In patients with H6C above 64, it would be wise to consider early liver transplantation to positively impact long-term survival, even when the MELD score is low. |
| first_indexed | 2024-03-10T15:44:45Z |
| format | Article |
| id | doaj.art-cb6a8d7ea8b24042955988fc96a50f9d |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-10T15:44:45Z |
| publishDate | 2020-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-cb6a8d7ea8b24042955988fc96a50f9d2023-11-20T16:32:34ZengMDPI AGDiagnostics2075-44182020-10-01101080510.3390/diagnostics10100805Application of Hepatic Venous Pressure Gradient to Predict Prognosis in Cirrhotic Patients with a Low Model for End-stage Liver Disease ScoreYoung Chang0Ki Tae Suk1Soung Won Jeong2Jeong-Ju Yoo3Sang Gyune Kim4Young Seok Kim5Sae Hwan Lee6Hong Soo Kim7Seong Hee Kang8Soon Koo Baik9Dong Joon Kim10Moon Young Kim11Jae Young Jang12Department of Internal Medicine, Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul 04401, KoreaDepartment of Internal Medicine, Institute for Liver and Digestive Diseases, Hallym University College of Medicine, Chuncheon 24252, KoreaDepartment of Internal Medicine, Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul 04401, KoreaDepartment of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon 14584, KoreaDepartment of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon 14584, KoreaDepartment of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon 14584, KoreaDepartment of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan 31151, KoreaDepartment of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan 31151, KoreaDepartment of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju 26426, KoreaDepartment of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju 26426, KoreaDepartment of Internal Medicine, Institute for Liver and Digestive Diseases, Hallym University College of Medicine, Chuncheon 24252, KoreaDepartment of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju 26426, KoreaDepartment of Internal Medicine, Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul 04401, KoreaBackground/aim: We aimed to derive a model representing the dynamic status of cirrhosis and to discriminate patients with poor prognosis even if the Model for End-Stage Liver Disease (MELD) score is low. Methods: This study retrospectively enrolled 700 cirrhotic patients with a MELD score of less than 20 who underwent hepatic venous pressure gradient (HVPG) measurement. A model named H6C score (= HVPG + 6 × CTP score) to predict overall survival was derived and internal and external validations were conducted with the derivation and validation cohorts. Results: The H6C score using the HVPG was developed based on a multivariate Cox regression analysis. The H6C score showed a great predictive power for overall survival with a time-dependent AUC of 0.733, which was superior to that of a MELD of 0.602. In patients with viral etiology, the performance of the H6C score was much improved with a time-dependent AUC of 0.850 and was consistently superior to that of the MELD (0.748). Patients with an H6C score below 45 demonstrated an excellent overall survival with a 5-year survival rate of 91.5%. Whereas, patients with an H6C score above 64 showed a dismal prognosis with a 5-year survival rate of 51.1%. The performance of the H6C score was further verified to be excellent in the validation cohort. Conclusion: This new model using the HVPG provides an excellent predictive power in cirrhotic patients, especially with viral etiology. In patients with H6C above 64, it would be wise to consider early liver transplantation to positively impact long-term survival, even when the MELD score is low.https://www.mdpi.com/2075-4418/10/10/805HVPGlow-MELDliver transplantation |
| spellingShingle | Young Chang Ki Tae Suk Soung Won Jeong Jeong-Ju Yoo Sang Gyune Kim Young Seok Kim Sae Hwan Lee Hong Soo Kim Seong Hee Kang Soon Koo Baik Dong Joon Kim Moon Young Kim Jae Young Jang Application of Hepatic Venous Pressure Gradient to Predict Prognosis in Cirrhotic Patients with a Low Model for End-stage Liver Disease Score Diagnostics HVPG low-MELD liver transplantation |
| title | Application of Hepatic Venous Pressure Gradient to Predict Prognosis in Cirrhotic Patients with a Low Model for End-stage Liver Disease Score |
| title_full | Application of Hepatic Venous Pressure Gradient to Predict Prognosis in Cirrhotic Patients with a Low Model for End-stage Liver Disease Score |
| title_fullStr | Application of Hepatic Venous Pressure Gradient to Predict Prognosis in Cirrhotic Patients with a Low Model for End-stage Liver Disease Score |
| title_full_unstemmed | Application of Hepatic Venous Pressure Gradient to Predict Prognosis in Cirrhotic Patients with a Low Model for End-stage Liver Disease Score |
| title_short | Application of Hepatic Venous Pressure Gradient to Predict Prognosis in Cirrhotic Patients with a Low Model for End-stage Liver Disease Score |
| title_sort | application of hepatic venous pressure gradient to predict prognosis in cirrhotic patients with a low model for end stage liver disease score |
| topic | HVPG low-MELD liver transplantation |
| url | https://www.mdpi.com/2075-4418/10/10/805 |
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