Liu Chuan, Shao Ruoyang, Wang Sining, Wang Guangchuan, Wang Lifen, Zhang Mingyan, Liu Yanna, Liang Mingkai, Li Xiaoguo, Kang Ning, Wang Jitao, Xu Dan, Mao Hua, Zhang Chunqing, Qi Xiaolong
Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, Guangzhou 510000, China.
Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510000, China.
Gastroenterol Res Pract. 2020 Nov 24;2020:1329857. doi: 10.1155/2020/1329857. eCollection 2020.
Gastroesophageal variceal bleeding is a serious complication of portal hypertension in cirrhotic patients and could be predicted by hepatic venous pressure gradient (HVPG). However, whether the presence of ascites affects the prognostic value of HVPG for patients with acute variceal bleeding is still unknown. This retrospective study is aimed at investigating the influence of ascites on predictive performance of HVPG for early rebleeding in cirrhotic patients with acute variceal bleeding.
In this retrospective study, a total of 148 patients with cirrhosis hospitalized for acute variceal bleeding who underwent HVPG measurement and endoscopic variceal ligation (EVL) for the prevention of rebleeding were included. The receiver operating characteristic curve (ROC) and logistical regression method were employed to analyze the predictive performance of HVPG for early rebleeding. The locally weighted scatterplot smoothing approach was adopted to assess the monotonicity between bleeding risk and HVPG.
A significantly higher HVPG level was observed in patients with early rebleeding compared to patients without rebleeding in the nonascites cohort. When using HVPG to predict early rebleeding, there was a lower area under curve in the ascites cohort compared to the nonascites cohort. HVPG was recognized as a risk factor for early rebleeding by a logistic regression model only in the nonascites cohort. An overall monotonicity in the trend of change in HVPG and risk for early rebleeding was observed in the nonascites cohort solely.
The predictive value of HVPG for early rebleeding in patients with cirrhosis that developed acute variceal bleeding is hindered by the presence of ascites.
胃食管静脉曲张出血是肝硬化患者门静脉高压的严重并发症，可通过肝静脉压力梯度（HVPG）进行预测。然而，腹水的存在是否会影响HVPG对急性静脉曲张出血患者的预后价值仍不清楚。这项回顾性研究旨在探讨腹水对肝硬化急性静脉曲张出血患者HVPG预测早期再出血性能的影响。
在这项回顾性研究中，共纳入148例因急性静脉曲张出血住院的肝硬化患者，这些患者接受了HVPG测量和内镜下静脉曲张结扎术（EVL）以预防再出血。采用受试者工作特征曲线（ROC）和逻辑回归方法分析HVPG对早期再出血的预测性能。采用局部加权散点图平滑法评估出血风险与HVPG之间的单调性。
在非腹水队列中，早期再出血患者的HVPG水平明显高于未再出血患者。当使用HVPG预测早期再出血时，腹水队列的曲线下面积低于非腹水队列。仅在非腹水队列中，逻辑回归模型将HVPG识别为早期再出血的危险因素。仅在非腹水队列中观察到HVPG变化趋势与早期再出血风险之间的总体单调性。
腹水的存在阻碍了HVPG对发生急性静脉曲张出血的肝硬化患者早期再出血的预测价值。
