Wattanachayakul Phuuwadith, Martinez Manzano Jose M, Geller Andrew, Malin John, Leguizamon Raul, John Tara A, Khan Rasha, McLaren Ian, Prendergast Alexander, Jarrett Simone A, Sarvottam Kumar, Lo Kevin B
Department of Medicine, Jefferson Einstein Hospital, Sidney Kimmel College of Medicine, Philadelphia, PA, USA.
Division of Pulmonary and Critical Care, Department of Medicine, Jefferson Einstein Hospital, Sidney Kimmel College of Medicine, Philadelphia, PA, USA.
J Clin Exp Hepatol. 2024 Nov-Dec;14(6):101470. doi: 10.1016/j.jceh.2024.101470. Epub 2024 Jun 20.
Despite advances in the diagnosis and therapeutics strategies for pulmonary hypertension (PH) in patients with end-stage liver disease (ESLD), the impact of hemodynamic patterns among ESLD patients identified through right heart catheterization (RHC) on clinical outcomes remains poorly understood.
This single-center retrospective cohort study identified patients diagnosed with ESLD who underwent RHC from August 2018 to June 2023. Demographic and clinical data, including comorbidities, transthoracic echocardiography, and RHC findings, were obtained. Our outcomes of interest were all-cause mortality and the chance of receiving orthotopic liver transplantation (OLT) within a year after RHC. Kaplan-Meier with log-rank test was employed to generate survival curves.
We identified 415 ESLD patients with the RHC results. The median (IQR) age was 59 years (52-66), and 62% were male. Caucasians accounted for 43%, followed by African Americans (30%). Up to 89% had a diagnosis of portal hypertension. Median MELD-Na score was 30 (19-36). The etiology of ESLD was mainly from alcohol use (55%). Patients were classified based on RHC results as pre-capillary PH (19%), post-capillary PH (28%), and non-PH (53%) groups. Overall, one-year mortality post-RHC was 22%, with no significant difference in mortality regardless of hemodynamic group. However, the pre-capillary PH group was less likely to receive OLT compared to other groups ( < 0.001).
We observed no difference in all-cause mortality among hemodynamic groups. However, pre-capillary PH group were less likely to undergo OLT compared to others. Further investigations are necessary to determine how this should be addressed in clinical practice.
尽管终末期肝病（ESLD）患者肺动脉高压（PH）的诊断和治疗策略取得了进展，但通过右心导管检查（RHC）确定的ESLD患者血流动力学模式对临床结局的影响仍知之甚少。
这项单中心回顾性队列研究确定了2018年8月至2023年6月期间接受RHC的ESLD诊断患者。获取了人口统计学和临床数据，包括合并症、经胸超声心动图和RHC结果。我们感兴趣的结局是全因死亡率和RHC后一年内接受原位肝移植（OLT）的机会。采用Kaplan-Meier法和对数秩检验生成生存曲线。
我们确定了415例有RHC结果的ESLD患者。中位（IQR）年龄为59岁（52-66岁），62%为男性。白种人占43%，其次是非裔美国人（30%）。高达89%的患者诊断为门静脉高压。中位MELD-Na评分为30（19-36）。ESLD的病因主要来自酒精使用（55%）。根据RHC结果，患者分为毛细血管前性PH组（19%）、毛细血管后性PH组（28%）和非PH组（5）。总体而言，RHC后一年的死亡率为22%，无论血流动力学组如何，死亡率均无显著差异。然而，与其他组相比，毛细血管前性PH组接受OLT的可能性较小（<0.001）。
我们观察到血流动力学组之间全因死亡率无差异。然而，与其他组相比，毛细血管前性PH组接受OLT的可能性较小。需要进一步研究以确定在临床实践中应如何解决这一问题。
