PDF(Pubmed)
Abstract：
UNASSIGNED: Despite advances in the diagnosis and therapeutics strategies for pulmonary hypertension (PH) in patients with end-stage liver disease (ESLD), the impact of hemodynamic patterns among ESLD patients identified through right heart catheterization (RHC) on clinical outcomes remains poorly understood.
UNASSIGNED: This single-center retrospective cohort study identified patients diagnosed with ESLD who underwent RHC from August 2018 to June 2023. Demographic and clinical data, including comorbidities, transthoracic echocardiography, and RHC findings, were obtained. Our outcomes of interest were all-cause mortality and the chance of receiving orthotopic liver transplantation (OLT) within a year after RHC. Kaplan-Meier with log-rank test was employed to generate survival curves.
UNASSIGNED: We identified 415 ESLD patients with the RHC results. The median (IQR) age was 59 years (52-66), and 62% were male. Caucasians accounted for 43%, followed by African Americans (30%). Up to 89% had a diagnosis of portal hypertension. Median MELD-Na score was 30 (19-36). The etiology of ESLD was mainly from alcohol use (55%). Patients were classified based on RHC results as pre-capillary PH (19%), post-capillary PH (28%), and non-PH (53%) groups. Overall, one-year mortality post-RHC was 22%, with no significant difference in mortality regardless of hemodynamic group. However, the pre-capillary PH group was less likely to receive OLT compared to other groups (P < 0.001).
UNASSIGNED: We observed no difference in all-cause mortality among hemodynamic groups. However, pre-capillary PH group were less likely to undergo OLT compared to others. Further investigations are necessary to determine how this should be addressed in clinical practice.
UNASSIGNED: This single-center retrospective cohort study identified patients diagnosed with ESLD who underwent RHC from August 2018 to June 2023. Demographic and clinical data, including comorbidities, transthoracic echocardiography, and RHC findings, were obtained. Our outcomes of interest were all-cause mortality and the chance of receiving orthotopic liver transplantation (OLT) within a year after RHC. Kaplan-Meier with log-rank test was employed to generate survival curves.
UNASSIGNED: We identified 415 ESLD patients with the RHC results. The median (IQR) age was 59 years (52-66), and 62% were male. Caucasians accounted for 43%, followed by African Americans (30%). Up to 89% had a diagnosis of portal hypertension. Median MELD-Na score was 30 (19-36). The etiology of ESLD was mainly from alcohol use (55%). Patients were classified based on RHC results as pre-capillary PH (19%), post-capillary PH (28%), and non-PH (53%) groups. Overall, one-year mortality post-RHC was 22%, with no significant difference in mortality regardless of hemodynamic group. However, the pre-capillary PH group was less likely to receive OLT compared to other groups (P < 0.001).
UNASSIGNED: We observed no difference in all-cause mortality among hemodynamic groups. However, pre-capillary PH group were less likely to undergo OLT compared to others. Further investigations are necessary to determine how this should be addressed in clinical practice.
摘要：
尽管终末期肝病（ESLD）患者肺动脉高压（PH）的诊断和治疗策略取得了进展，通过右心导管插入术(RHC)确定的ESLD患者的血流动力学模式对临床结局的影响尚不清楚.
■这项单中心回顾性队列研究确定了2018年8月至2023年6月接受RHC的诊断为ESLD的患者。人口统计学和临床数据，包括合并症,经胸超声心动图,和RHC的发现，已获得。我们感兴趣的结果是全因死亡率和RHC后一年内接受原位肝移植（OLT）的机会。采用对数秩检验的Kaplan-Meier生成存活曲线。
■我们确定了415名具有RHC结果的ESLD患者。中位年龄（IQR）为59岁（52-66），62%为男性。白种人占43%,其次是非洲裔美国人（30%）。高达89％的人被诊断为门静脉高压症。MELD-Na评分中位数为30(19-36)。ESLD的病因主要来自酒精使用（55％）。根据RHC结果将患者分类为毛细血管前PH（19％），毛细管后PH（28%），和非PH（53％）组。总的来说,RHC后一年死亡率为22%，与血流动力学组无关，死亡率无显著差异。然而,与其他组相比,毛细血管前PH组接受OLT的可能性较小(P<0.001).
■我们观察到血流动力学组的全因死亡率无差异。然而,与其他组相比，毛细血管前PH组不太可能接受OLT。需要进一步的调查以确定在临床实践中应如何解决这一问题。
■这项单中心回顾性队列研究确定了2018年8月至2023年6月接受RHC的诊断为ESLD的患者。人口统计学和临床数据，包括合并症,经胸超声心动图,和RHC的发现，已获得。我们感兴趣的结果是全因死亡率和RHC后一年内接受原位肝移植（OLT）的机会。采用对数秩检验的Kaplan-Meier生成存活曲线。
■我们确定了415名具有RHC结果的ESLD患者。中位年龄（IQR）为59岁（52-66），62%为男性。白种人占43%,其次是非洲裔美国人（30%）。高达89％的人被诊断为门静脉高压症。MELD-Na评分中位数为30(19-36)。ESLD的病因主要来自酒精使用（55％）。根据RHC结果将患者分类为毛细血管前PH（19％），毛细管后PH（28%），和非PH（53％）组。总的来说,RHC后一年死亡率为22%，与血流动力学组无关，死亡率无显著差异。然而,与其他组相比,毛细血管前PH组接受OLT的可能性较小(P<0.001).
■我们观察到血流动力学组的全因死亡率无差异。然而,与其他组相比，毛细血管前PH组不太可能接受OLT。需要进一步的调查以确定在临床实践中应如何解决这一问题。
