Comparison of MELD, HVPG, and their changes to predict clinically relevant endpoints in cirrhosis
Comparison of MELD, HVPG, and their changes to predict clinically relevant endpoints in cirrhosis
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DOI：
10.3109/00365521.2011.645500
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发表时间：
2012-02-01
影响因子：
1.9
通讯作者：
Banares, Rafael
中科院分区：
文献类型：
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作者：
Ripoll, Cristina;Lastra, Paola;Banares, Rafael
瞄准肝硬化自然史中预测因子的识别是基于固定时间点的测定。然而，这些预测因子的变化可能会提供更多的信息。目的探讨终末期肝病模型（MELD）和肝静脉压力梯度（HVPG）及其变化对肝硬化的预测价值。方法.考虑纳入2000年1月至2008年12月期间重复HVPG测量的患者。随访患者直至失代偿/死亡或2009年7月。采用多变量考克斯回归分析MELD和HVPG单次测量的预测值以及测量之间的变化。分别分析了代偿期和失代偿期患者。结果纳入117例患者（51例代偿，66例失代偿）。测量和随访之间的中位时间在代偿期患者中分别为13（2-24）和11（6-38）个月，在失代偿期患者中分别为8（1-16）和10（3-21）个月。15例代偿期患者发生失代偿，12例失代偿期患者死亡。在多变量分析中，MELD（HR 1.12（95% CI 1-1.24））和HVPG（HR 1.16（95% CI 1.04-1.29））是代偿期失代偿的独立预测因子，而MELD（HR 1.18（95% CI 1.09-1.27））是失代偿期死亡的唯一预测因子。结论MELD和HVPG的单次和重复测量与肝硬化的结局相关。使用重复测量似乎不能增加更多信息。
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.