비대상성 간경변증 환자의 예후지표로서 Model for End-stage Liver Disease와 간정맥압차의 비교
Comparison of the Model for End-stage Liver Disease and hepatic venous pressure gradient for predicting survival in patients with decompensated liver cirrhosis
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목적: 비대상성 간경변증 환자에서 3개월과 12개월 시점의 간정맥압차와 MELD의 사망예측 정확도를 비교하여, HVPG의 예후인자로서의 역할을 확인하고자 하였다. 대상과 방법: 2006년 1월부터 2008년 6월까지 한림대학교부속 춘천성심병원에서 136명의 비대상성 간경변증 환자를 대상으로 HVPG를 측정하였다. 생존분석의 1차 결과 변수로서 3개월과 12개월에서의 사망 여부를 확인하였다. 결과: Cox 회귀분석 결과, MELD와 HVPG 모두 독립적인 예후인자로 확인되었다[각각 hazard ratio는 1.11(95% CI, 1.04 to 1.20)과 1.12(95% CI, 1.08 to 1.16)]. 두 변수의 ROC곡선의 AUC를 비교해 볼 때, 3개월에서 유의하진 않지만 MELD는 HVPG보다 사망예측에 있어서 정확도가 8% 정도 더 높게 보였다[0.76(95% CI, 0.62 to 0.89) 대 0.68(95% CI, 0.52 to 0.84), P=0.22]. 12개월에서는 MELD와 HVPG 모두 비슷한 사망예측의 정확도를 보였다[0.72(95% CI, 0.61 to 0.83) 대 0.73 (95% CI, 0.61 to 0.84), P=0.45,]. 결론: MELD와 HVPG는 비대상성 간경변증 환자에서 사망과 관련된 독립적인 예후인자로서 사망예측의 정확도에 있어서 유의한 차이를 보이지 않는다. 하지만 HVPG는 침습적이고 소수의 의료기관에서만 시행된다는 점에서 사망예측인자로서 HVPG의 역할은 제한적이라 판단된다. 그러나 HVPG의 다양한 예후인자로서의 임상적 역할을 규정하기 위해서는 폭넓은 환자군(원인, 성별, 지역, 등)을 대상으로 하는 전향연구가 필요하다.
Abstract
Backgrounds/Aims: This study compared the prognostic values of the Model for End-stage Liver Disease (MELD) and the hepatic venous pressure gradient (HVPG) in the prediction of death within 3 and 12 months in patients with decompensated liver cirrhosis. Methods: We used data from 136 consecutive patients with decompensated cirrhosis who underwent HVPG between January 2006 and June 2008. Cox regression analysis was used to investigate the independent relationships with death of MELD and HVPG. The prognostic accuracies of MELD and HVPG were analyzed by calculating the area under the receiver operating characteristic curve (AUROC) for the occurrence of death within 3 and 12 months. Results: Both MELD and HVPG were independent predictors of death [hazard ratio (HR)=1.11 and 1.12, respectively; 95% confidence interval (CI)=1.04～1.20 and 1.08-1.16]. Analysis of the AUROC demonstrated that the prognostic power did not differ between MELD and HVPG for predicting the 3-month survival (HR=0.76 and 0.68, respectively; 95% CI=0.62～0.89 and 0.52～0.84; P=0.22) or the 12-month survival (HR=0.72 and 0.73, 95% CI=0.61～0.83 and CI=0.61～0.84). Conclusions: Both MELD and HVPG are independent prognostic factors of death within 3 and 12 months in patients with decompensated liver cirrhosis, and their accuracies are similar. However, HVPG has a limited role in the prediction of death in decompensated cirrhosis due to its invasiveness and limited use.
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