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Prediction of survival in patients with cirrhosis

Hepatic venous pressure gradient has an independent effect on survival in addition to the MELD score, and improves the calibrative ability of MELD, finds the latest issue of Hepatology.

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Measurements of portal pressure, usually obtained via the hepatic venous pressure gradient may be a prognostic marker in cirrhosis.

Dr Rafael Bañares from Spain examined the inclusion of hepatic venous pressure gradient with Model for End-Stage Liver Disease (MELD) variables.

The researchers therefore evaluated whether this combination improves survival in patients with cirrhosis, as well as the models prognostic ability.

Retrospective analyses of all patients who had hepatic venous pressure gradient measurements between 1998 and 2002 were considered.

The research team developed proportional hazards Cox models, and evaluated prognostic calibrative and discriminative ability of the model.

1-mmHg increase in hepatic venous pressure gradient had a 3% increase in death risk
Hepatology

In this period, 693 patients had a hepatic hemodynamic study, and the team included 393 patients.

The researchers found that survival was significantly worse in those patients with greater hepatic venous pressure gradient value.

Hepatic venous pressure gradient remained as an independent variable in a model adjusted by MELD, ascites, encephalopathy, and age.

The research team observed that so that each 1-mmHg increase in hepatic venous pressure gradient had a 3% increase in death risk.

The team noted that hepatic venous pressure gradient significantly contributes to the calibrative predictive capacity of the prognostic model.

In addition, MELD score variables and age, were found to significantly contributes to the calibrative predictive capacity of the prognostic model.

However, discriminative ability improved only slightly.

Dr Bañares' team concluded, “Hepatic venous pressure gradient has an independent effect on survival in addition to the MELD score.”

“Although inclusion of hepatic venous pressure gradient and age in a survival predicting model would improve the calibrative ability of MELD, its discriminative ability is not significantly improved.”

Hepatol 2005: 42(4): 793-801
23 September 2005

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