Department of Internal Medicine, New Hope Internal Medicine Clinic, Seoul, Korea.
Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea.
J Korean Med Sci. 2019 Aug 26;34(33):e223. doi: 10.3346/jkms.2019.34.e223.
This study aimed to determine the prognostic role of the categorized hemodynamic stage (HS) based on the hepatic venous pressure gradient (HVPG) in patients with portal hypertension.
Of 1,025 cirrhotic patients who underwent HVPG measurement, data on 572 non-critically-ill patients were collected retrospectively between 2008 and 2013. The following two HS categorizations were used: HS-1 (6-9, 10-12, 13-16, 17-20, and > 20 mmHg; designated as groups 1-5, respectively) and HS-2 (6-12, 13-20, and > 20 mmHg). Clinical characteristics, mortality rates, and prognostic predictors were analyzed according to the categorized HS.
During the mean follow-up period of 25 months, 86 (15.0%) patients died. The numbers of deaths in HS-1 groups were 7 (6.3%), 7 (6.9%), 30 (18.0%), 20 (15.6%), and 22 (34.4%), respectively ( < 0.001). However, the traditional HVPG cutoffs of 10 and 16 mmHg did not improve the discrimination of mortality. In contrast, the mortality rates did differ significantly between the three HS-2 groups ( < 0.05). In the multivariate analysis, all models revealed that HS-2 was a common prognostic factor in predicting mortality. The mortality rates increased significantly according to HS-2 in patients with hypoalbuminemia (HVPG, 13-20 mmHg; hazard ratio [HR], 2.54 and HVPG > 20 mmHg; HR, 5.45) and intermediate model for end-stage liver disease (MELD) score (HVPG, 13-20 mmHg; HR, 3.86 and HVPG > 20 mmHg; HR, 8.77; < 0.05).
Categorizing HVPG values according to HS-2 is a useful prognostic modality in patients with portal hypertension and can play an independent role in predicting the prognosis in patients with hypoalbuminemia and an intermediate MELD score.
本研究旨在确定基于肝静脉压力梯度（HVPG）的分类血流动力学阶段（HS）在门静脉高压患者中的预后作用。
在对 1025 例肝硬化患者进行 HVPG 测量中，回顾性收集了 2008 年至 2013 年间 572 例非危重症患者的数据。使用以下两种 HS 分类：HS-1（6-9、10-12、13-16、17-20 和>20mmHg；分别指定为组 1-5）和 HS-2（6-12、13-20 和>20mmHg）。根据分类 HS 分析临床特征、死亡率和预后预测因素。
在平均 25 个月的随访期间，86 例（15.0%）患者死亡。HS-1 组的死亡人数分别为 7（6.3%）、7（6.9%）、30（18.0%）、20（15.6%）和 22（34.4%）（<0.001）。然而，传统的 HVPG 截断值 10 和 16mmHg 并不能提高死亡率的区分度。相比之下，HS-2 的三个亚组之间的死亡率差异有统计学意义（<0.05）。在多变量分析中，所有模型均表明，HS-2 是预测死亡率的共同预后因素。在低白蛋白血症（HVPG，13-20mmHg；危险比[HR]，2.54 和 HVPG>20mmHg；HR，5.45）和中间终末期肝病模型（MELD）评分（HVPG，13-20mmHg；HR，3.86 和 HVPG>20mmHg；HR，8.77）的患者中，HS-2 显著增加了死亡率（<0.05）。
根据 HS-2 对 HVPG 值进行分类是一种有用的门静脉高压患者预后模式，可在低白蛋白血症和中间 MELD 评分患者的预后预测中发挥独立作用。
