Influence of Hepatic Venous Pressure Gradient on the... : Hepatology (original) (raw)

Liver Failure and Liver Disease

Influence of Hepatic Venous Pressure Gradient on the Prediction of Survival of Patients With Cirrhosis in the MELD Era*

Ripoll, Cristina1; Bañares, Rafael1†∥; Rincón, Diego1; Catalina, María-Vega1; Lo Iacono, Oreste1; Salcedo, Magdalena1; Clemente, Gerardo1; Núñez, Oscar1; Matilla, Ana1; Molinero, Luis-Miguel2

1 Sección de Hepatología, Servicio de Aparato Digestivo, Hospital Gregorio Marañón, Madrid, Spain

2 Alce Ingenieria, Las Rozas (Madrid), Spain

† Sección de Hepatología, Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Dr Esquerdo, 46 Madrid, Spain 28007

Email:[email protected]

Received 19 May 2005; Accepted 20 July 2005

Published online in Wiley InterScience (www.interscience.wiley.com).

Grant sponsor: Fondo de Investigaciones Sanitarias (FIS); Grant Number: CM 03/00037; Grant sponsor: Fundación de Investigación Biomédica del Hospital Gregorio Marañón.

*Potential conflict of interest: Nothing to report.

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Abstract

Measurements of portal pressure, usually obtained via the hepatic venous pressure gradient (HVPG) may be a prognostic marker in cirrhosis. The aim of this study was to evaluate the impact of HVPG on survival in patients with cirrhosis in addition to the Model for End-Stage Liver Disease (MELD) score. We also examined whether inclusion of HVPG in a model with MELD variables improves its prognostic ability. Retrospective analyses of all patients who had HVPG measurements between January 1998 and December 2002 were considered. Proportional hazards Cox models were developed. Prognostic calibrative and discriminative ability of the model was evaluated. In this period, 693 patients had a hepatic hemodynamic study, and 393 patients were included. Survival was significantly worse in those patients with greater HVPG value (univariate HR, 1.05; 95% CI, 1.02-1.08; P = .001). HVPG remained as an independent variable in a model adjusted by MELD, ascites, encephalopathy, and age (multivariate HR, 1.03; 95% CI, 1.00-1.06; P = .05) so that each 1-mmHg increase in HVPG had a 3% increase in death risk. In addition, HVPG as well as MELD score variables and age, significantly contributes to the calibrative predictive capacity of the prognostic model; however, discriminative ability improved only slightly (overall C statistic [95% CI]; MELD score variables: 0.71 [0.62-0.80], MELD score variables, age, and HVPG 0.76: [0.69-0.83]).In conclusion, HVPG has an independent effect on survival in addition to the MELD score. Although inclusion of HVPG and age in a survival predicting model would improve the calibrative ability of MELD, its discriminative ability is not significantly improved. (Hepatology 2005;42:793–801.)