Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2026
The value of hepatic venous pressure gradient in patients with pyrrolidine alkaloid-induced hepatic sinusoidal obstruction syndrome.
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Cai Zihao, Li Ruiqi, Zhang Feng, Yin Qin, Han Hao, Chen Jun, Li Taishun, Tu Jingjing, Zhuge Yuzheng, Xiao Jiangqiang
Аннотация
BACKGROUND: Pyrrolidine alkaloid-induced hepatic sinusoidal obstruction syndrome (PA-HSOS) is characterized by rapidly progressive portal hypertension. Hepatic venous pressure gradient (HVPG) is the gold standard for the diagnosis of sinusoidal portal hypertension. However, the role of HVPG in evaluating disease severity and treatment choice in patients with PA-HSOS needs further verification. This study aimed to investigate the clinical value of HVPG in patients with PA-HSOS.
METHODS: Patients who were diagnosed with PA-HSOS according to the "Nanjing criteria" and received HVPG measurements in our hospital between January 2016 and April 2020 were retrospectively reviewed.
RESULTS: Multivariate logistic regression analysis identified HVPG as independently associated with nonresponse to initial anticoagulation (odds ratio [OR], 1.191 [95% CI, 1.004-1.413]; P =.044), and the area under the receiver operating characteristic curve (AUC) was 0.741 (95% CI, 0.626-0.857; P <.001). When HVPG of >20.165 mm Hg was combined with serum total bilirubin, heart rate, and blood urea nitrogen for modeling, the AUC was 0.881 (95% CI, 0.804-0.958; P <.001). In addition, there was a linear correlation between HVPG and the bleeding area of hepatic sinusoids (BAHS) in 76 patients (P =.008 and R =.343). Furthermore, after excluding patients with an onset time of more than 1 month, HVPG improved the efficacy in predicting nonresponse to anticoagulant therapy (AUC, 0.789 [95% CI, 0.654-0.924]; P =.001), and the linear relationship between HVPG and BAHS was enhanced (P =.001 and R =.499).
CONCLUSION: HVPG can assist in predicting the outcome of anticoagulant therapy in patients with PA-HSOS, and this prediction is more accurate for patients within 1 month of disease onset.
METHODS: Patients who were diagnosed with PA-HSOS according to the "Nanjing criteria" and received HVPG measurements in our hospital between January 2016 and April 2020 were retrospectively reviewed.
RESULTS: Multivariate logistic regression analysis identified HVPG as independently associated with nonresponse to initial anticoagulation (odds ratio [OR], 1.191 [95% CI, 1.004-1.413]; P =.044), and the area under the receiver operating characteristic curve (AUC) was 0.741 (95% CI, 0.626-0.857; P <.001). When HVPG of >20.165 mm Hg was combined with serum total bilirubin, heart rate, and blood urea nitrogen for modeling, the AUC was 0.881 (95% CI, 0.804-0.958; P <.001). In addition, there was a linear correlation between HVPG and the bleeding area of hepatic sinusoids (BAHS) in 76 patients (P =.008 and R =.343). Furthermore, after excluding patients with an onset time of more than 1 month, HVPG improved the efficacy in predicting nonresponse to anticoagulant therapy (AUC, 0.789 [95% CI, 0.654-0.924]; P =.001), and the linear relationship between HVPG and BAHS was enhanced (P =.001 and R =.499).
CONCLUSION: HVPG can assist in predicting the outcome of anticoagulant therapy in patients with PA-HSOS, and this prediction is more accurate for patients within 1 month of disease onset.