Rincón Diego, Lo Iacono Oreste, Tejedor Marta, Hernando Ana, Ripoll Cristina, Catalina María-Vega, Salcedo Magdalena, Matilla Ana, Senosiain María, Clemente Gerardo, Molinero Luis-Miguel, Albillos Agustín, Bañares Rafael
Hepatic Hemodynamic Laboratory, Liver Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Scand J Gastroenterol. 2013 Apr;48(4):487-95. doi: 10.3109/00365521.2012.711848. Epub 2012 Aug 8.
Hepatic venous pressure gradient (HVPG) is the main predictor of clinical decompensation in cirrhotic patients with compensated disease of any etiology without varices. However, the predictive factors of decompensation are not so well known in patients with hepatitis C-related compensated cirrhosis, in whom etiology-based therapy is difficult. The aim of this study was to identify predictors of decompensation in patients with compensated chronic hepatitis C (CHC)-related cirrhosis with and without esophageal varices (Baveno stages 1 and 2).
The study population was a cohort of 145 of such consecutive patients who received hepatic hemodynamic study. All patients were similarly followed every 6 months. Through multivariate Cox regression and bootstrap analyses, a prognostic index (PI) was developed and tested in an external cohort (n = 38).
Forty-two patients (29%) suffered a first decompensation episode after a median follow-up of 27 months (2-110). Cox regression analysis identified HVPG (hazard ratio (HR) 1.11; 95% confidence interval (CI): 1.05-1.17) and albumin (HR 0.42; 95% CI: 0.22-0.82) as independent predictors of decompensation. Bootstrapping confirmed that HVPG (95% CI: 1.05-1.18) and albumin (95% CI: 0.12-0.74) were the most robust predictive variables. Using a cut-off level of 2.5, the PI [4 + (0.11 × HVPG - 0.8 × albumin)] was able to distinguish two populations of patients with very different risks of decompensation in both the exploratory and validation cohorts. A time-dependent ROC curve identified HVPG as the best predictive variable.
HVPG and albumin are independent predictors of clinical decompensation in patients with compensated CHC-related cirrhosis irrespective of the existence of varices.
肝静脉压力梯度（HVPG）是任何病因所致无静脉曲张的代偿期肝硬化患者临床失代偿的主要预测指标。然而，丙型肝炎相关代偿期肝硬化患者失代偿的预测因素尚不明确，此类患者基于病因的治疗存在困难。本研究旨在确定伴有和不伴有食管静脉曲张（巴韦诺1期和2期）的代偿期慢性丙型肝炎（CHC）相关肝硬化患者失代偿的预测因素。
研究人群为145例接受肝脏血流动力学研究的此类连续患者队列。所有患者均每6个月进行类似随访。通过多变量Cox回归和自抽样分析，制定了一个预后指数（PI）并在一个外部队列（n = 38）中进行测试。
42例患者（29%）在中位随访27个月（2 - 110个月）后发生首次失代偿事件。Cox回归分析确定HVPG（风险比（HR）1.11；95%置信区间（CI）：1.05 - 1.17）和白蛋白（HR 0.42；95% CI：0.22 - 0.82）为失代偿的独立预测因素。自抽样证实HVPG（95% CI：1.05 - 1.18）和白蛋白（95% CI：0.12 - 0.74）是最可靠的预测变量。使用截断值2.5，PI [4 +（0.11×HVPG - 0.8×白蛋白）]能够在探索性队列和验证性队列中区分出失代偿风险差异很大的两组患者。时间依赖性ROC曲线确定HVPG为最佳预测变量。
无论是否存在静脉曲张，HVPG和白蛋白都是代偿期CHC相关肝硬化患者临床失代偿的独立预测因素。
