The Agreement And Clinical Significance Of Wedge Hepatic Vein Pressure And Portal Vein Pressure In Patients With Pyrrole Alkaloid-related Hepatic Sinusoidal Obstruction Syndrome

ObjectiveWedge hepatic vein pressure(WHVP)accurately estimates the portal pressure(PP)in chronic sinusoidal portal hypertension patients.Whether this applies to patients with acute portal hypertension due to pyrrole alkaloid-related hepatic sinusoidal obstruction syndrome(PA-HSOS)is unclear.Therefore,this study explores the correlation and clinical significance of WHVP and PP in PA-HSOS.MethodsPatients with(PA-HSOS)who underwent hepatic venous pressure gradient(HVPG)measurements and transjugular intrahepatic portosystemic shunt(TIPS)at the Department of Gastroenterology,Drum Tower Hospital,from December 2013 to December 2021(PA-HSOS group,n=30)were enrolled in the study,and were treated with concurrent TIPS of viral cirrhosis or alcoholic cirrhosis(cirrhosis group,n=34)were matched,and clinical data such as general patient data,laboratory tests,and intraoperative portal pressure-related manometry values were collected.Pearson correlation coefficient(R),intra-group correlation coefficient(ICC),scatter plot,and Bland-Altma plot were used for WHVP and PP concordance evaluation.Comparison of clinical and laboratory characteristics between HVPG and PA-HSOS patients using t-test.And the independent risk factors associated with poor prognosis after TIPS in PA-HSOS patients were analyzed by univariate and multifactorial Cox regression analysis according to the follow-up results.The predictive value of intraoperative portal pressure-related manometry in TIPS on patients’ survival after TIPS was assessed by receiver operating characteristic(ROC)curves.ResultsA total of 64 patients were analyzed(30 PA-HSOS and 34 cirrhosis groups).The correlation between WHVP and PP was moderate in the PA-HSOS group(R:0.58,p=0.001;ICC:0.68,p=0.002)but good in the cirrhosis group(R:0.81,p<0.001;ICC:0.90,p<0.001).The percentage of patients with inconsistent WHVP and PP in the two groups was 13(43.3%)and 15(26.5%)(p=0.156),respectively,and an overestimation of PP was more common in the PA-HSOS group(33.3% vs.2.9%,p=0.004).HVPG and portal pressure gradient(PPG)consistency was poor in both groups(R:0.51 vs.0.26;ICC:0.65 vs.0.41;p<0.05).During a median follow-up of 20.7months,a total of 5 patients died.The prediction model of postoperative death risk of TIPS was established: Multivariate Cox regression analysis showed that postoperative PPG(p=0.028)and preoperative serum total bilirubin(p=0.048)levels were independent risk factors for postoperative death in HSOS patients with TIPS,and the areas under ROC curve were 0.944 and 0.856,respectively.Multivariate logistic regression analysis showed that fibrinogen was an independent risk factor for higher postoperative PPG level.ConclusionWHVP in patients with PA-HSOS did not estimate PP as accurately as in patients with virus-or alcohol-related cirrhosis,which was mainly due to PP overestimation.Postoperative PPG and operative serum total bilirubin are independent risk factors for poor prognosis after TIPS treatment in PA-HSOS patients.Based on the above two indicators,an effective mortality risk prediction model was constructed to provide reference for clinical medical workers to evaluate the prognosis of patients and make medical decisions.