Abstract
Background/aim: We aimed to derive a model representing the dynamic status of cirrhosis and to discriminate patients with poor prognosis even if the Model for End-Stage Liver Disease (MELD) score is low. Methods: This study retrospectively enrolled 700 cirrhotic patients with a MELD score of less than 20 who underwent hepatic venous pressure gradient (HVPG) measurement. A model named H6C score (= HVPG + 6 × CTP score) to predict overall survival was derived and internal and external validations were conducted with the derivation and validation cohorts. Results: The H6C score using the HVPG was developed based on a multivariate Cox regression analysis. The H6C score showed a great predictive power for overall survival with a time-dependent AUC of 0.733, which was superior to that of a MELD of 0.602. In patients with viral etiology, the performance of the H6C score was much improved with a time-dependent AUC of 0.850 and was consistently superior to that of the MELD (0.748). Patients with an H6C score below 45 demonstrated an excellent overall survival with a 5-year survival rate of 91.5%. Whereas, patients with an H6C score above 64 showed a dismal prognosis with a 5-year survival rate of 51.1%. The performance of the H6C score was further verified to be excellent in the validation cohort. Conclusion: This new model using the HVPG provides an excellent predictive power in cirrhotic patients, especially with viral etiology. In patients with H6C above 64, it would be wise to consider early liver transplantation to positively impact long-term survival, even when the MELD score is low.
Highlights
Various models have been suggested to predict the prognosis of patients with cirrhosis
We aimed to derive a model representing the dynamic status of cirrhosis to discriminate patients with poor prognosis even with a low Model for End-Stage Liver Disease (MELD) score
The area under the curve (AUC) of the H6C score were consistently higher than those of the MELD over time. This large-scale multicenter cohort study was designed to demonstrate the impact of Portal hypertension (PHT) on overall survival (OS) in cirrhotic patients with a low MELD score
Summary
Various models have been suggested to predict the prognosis of patients with cirrhosis. The MELD along with the Child-Turcotte-Pugh (CTP) scoring system is most commonly used to determine the extent of hepatic dysfunction and prognosis; direct evidence regarding the dynamic state of cirrhosis is not indicated in both models. Several indicators of portal hypertensive syndrome have been developed; of these, the measurement of hepatic venous pressure gradient (HVPG) is considered the most direct and accessible approach [11]. HVPG has been regarded as a surrogate indicator of PHT and widely used for risk stratification, prognostic assessment, and monitoring of treatment responses in patients with chronic liver disease [10,11]. A recent study has suggested that HVPG is beneficial in assessing the severity of PHT and treatment responses in real clinical practice [12]
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