Serum ascites albumin gradient in predicting the severity of hepatic sinusoidal obstruction syndrome induced by pyrrolizidine alkaloids.

AIM OF THE STUDY: Hepatic sinusoidal obstruction syndrome induced by pyrrolizidine alkaloids (PA-HSOS) is a form of drug-induced liver injury (DILI) associated with portal hypertension (PH). The serum-ascites albumin gradient (SAAG) is known to be directly related to PH. However, the clinical value of SAAG for predicting the severity of PA-HSOS is unknown. We aimed to evaluate the association between SAAG and hepatic venous pressure gradient (HVPG) and portal pressure (PP) in patients with PA-HSOS and to investigate the clinical value of SAAG for predicting the severity of PA-HSOS.

MATERIAL AND

METHODS

We retrospectively collected the clinical data from all patients with PA-HSOS undergoing PP measurement and abdominocentesis between January 2015 and December 2021. Pearson's correlation (R), intraclass correlation coefficient (ICC), and scatter plot analysis were performed to evaluate associations.

RESULTS

In total, 28 patients were analyzed. The correlation between SAAG and HVPG was moderate (R = 0.41, ICC = 0.40, p = 0.031), while the correlation between SAAG and wedge hepatic vein pressure (WHVP) was poor (R = 0.36, ICC = 0.34, p = 0.060). The correlation between SAAG and portal pressure gradient (PPG) was moderate (R = 0.49, ICC = 0.42, p = 0.030), while the correlation between SAAG and portal pressure was good (R = 0.57, ICC = 0.52, p = 0.008). SAAG differed significantly different between mild and moderate/severe patients according to the Drum Tower Severity Scoring (DTSS) system (15.3 vs. 17.7 g/l, p = 0.042).

CONCLUSIONS

The SAAG provides a simple and minimally invasive method for predicting the severity of PA-HSOS, and may facilitate prognostic prediction and treatment decisions.