Cristina Ripoll1, Paola Lastra, Diego Rincón, Vega Catalina, Rafael Bañares. 1. Digestive Diseases Department, Hospital General Universitario Gregorio Marañón, Liver and Transplant Unit, CiberEHD, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
Abstract
AIM: Identification of predictors in the natural history of cirrhosis is based on determinations at a fixed time point. However, changes of these predictors may offer more information. To evaluate the predictive value of Model for End Stage Liver Disease (MELD) and hepatic venous pressure gradient (HVPG) and their changes in cirrhosis. METHODS: Patients with repeat HVPG measurements between January 2000 and December 2008 were considered for inclusion. Patients were followed until decompensation/death or July 2009. Multivariate Cox regression was used to analyze the predictive value of a single measurement of MELD and HVPG, and changes between measurements. Compensated and decompensated patients were analyzed separately. RESULTS: One hundred and seventeen patients were included (51 compensated, 66 decompensated). Median time between measurements and follow-up was 13 (2-24) and 11 (6-38) months in compensated and 8 (1-16) and 10 (3-21) months in decompensated patients, respectively. Fifteen compensated patients developed decompensation while twelve decompensated patients died. On multivariate analysis, MELD (HR 1.12 (95% CI 1-1.24)) and HVPG (HR 1.16 (95% CI 1.04-1.29)) were independent predictors of decompensation in compensated, while MELD (HR 1.18 (95% CI 1.09-1.27)) was the only predictor of death in the decompensated. CONCLUSION: Single and repeat measurements of MELD and HVPG are associated to outcomes in cirrhosis. Use of repeat measurements does not seem to add further information.
AIM: Identification of predictors in the natural history of cirrhosis is based on determinations at a fixed time point. However, changes of these predictors may offer more information. To evaluate the predictive value of Model for End Stage Liver Disease (MELD) and hepatic venous pressure gradient (HVPG) and their changes in cirrhosis. METHODS:Patients with repeat HVPG measurements between January 2000 and December 2008 were considered for inclusion. Patients were followed until decompensation/death or July 2009. Multivariate Cox regression was used to analyze the predictive value of a single measurement of MELD and HVPG, and changes between measurements. Compensated and decompensated patients were analyzed separately. RESULTS: One hundred and seventeen patients were included (51 compensated, 66 decompensated). Median time between measurements and follow-up was 13 (2-24) and 11 (6-38) months in compensated and 8 (1-16) and 10 (3-21) months in decompensated patients, respectively. Fifteen compensated patients developed decompensation while twelve decompensated patients died. On multivariate analysis, MELD (HR 1.12 (95% CI 1-1.24)) and HVPG (HR 1.16 (95% CI 1.04-1.29)) were independent predictors of decompensation in compensated, while MELD (HR 1.18 (95% CI 1.09-1.27)) was the only predictor of death in the decompensated. CONCLUSION: Single and repeat measurements of MELD and HVPG are associated to outcomes in cirrhosis. Use of repeat measurements does not seem to add further information.
Authors: Sumeet K Asrani; Jayant A Talwalkar; Patrick S Kamath; Vijay H Shah; Giovanna Saracino; Linda Jennings; John B Gross; Sudhakar Venkatesh; Richard L Ehman Journal: J Hepatol Date: 2013-12-19 Impact factor: 25.083
Authors: Theresa Bucsics; Maria Schoder; Magdalena Diermayr; Maria Feldner-Busztin; Nicolas Goeschl; David Bauer; Philipp Schwabl; Mattias Mandorfer; Bernhard Angermayr; Manfred Cejna; Arnulf Ferlitsch; Wolfgang Sieghart; Michael Trauner; Markus Peck-Radosavljevic; Josef Karner; Franz Karnel; Thomas Reiberger Journal: PLoS One Date: 2018-01-09 Impact factor: 3.240