New hepatic venous outflow tract obstruction prognostic scores superior in India
At the All India Institute of Medical Sciences, new prognostic scores developed for hepatic venous outflow tract obstruction were superior to other scores, according to recent findings published in Alimentary Pharmacology and Therapeutics. Further, the researchers found child class and no response to intervention were associated with poor outcomes.
“Child class and response to intervention are important predictors of survival in hepatic venous outflow obstruction,” Shalimar, MBBS, assistant professor of gastroenterology at All India Institute of Medical Sciences (AAIMS), and colleagues wrote. “AAIMS hepatic venous outflow tract obstruction score is a better predictor of survival than the other prognostic indices in India.”
For hepatic venous outflow tract obstruction (HVOTO), hepatic veins are the most common block site in the West, the researchers wrote. In the East, a combined block involving both hepatic veins and the inferior vena cava is the most common. Because there are no studies of HVOTO prognostic scores in Asia, the scores currently available have been derived only from the European population. To ascertain better prognoses for their patients at AAIMS, Shalimar and colleagues developed and evaluated a new prognostic score.
The researchers screened 354 consecutive patients (median age, 24 years; 56.6% male) diagnosed with HVOTO at AAIMS and documented clinical response after endovascular interventional therapy. Afterward, they assessed predictors of survival using the Cox-proportional model. Using these predictors of survival, they developed a new prognostic score and compared it with the Child-Turcotte-Pugh model for end-stage liver disease, the Rotterdam prognostic index and the Budd-Chiari syndrome-transjugular intrahepatic portosystemic shunt (BCS-TIPSS) prognostic index.
The most common block site was hepatic vein (48%), followed by a combination of hepatic vein and inferior vena cava (46%). Endovascular therapy was performed in 70% of patients with 90% technical success. Clinical response was complete in 71.2%, partial in 24.9% and there was no response in 3.9%. Most cases with a blocked hepatic vein did not need TIPSS and could be treated with angioplasty. In the multivariate analysis, child class C and response to intervention were independent predictors of outcome and were both used to derive the AAIMS prognosis score for HVOTO. The 5-year survival rate was 92% (95% CI, 81-97) for a prognostic score no greater than 3 and 49% (95% CI, 63-88) for a score between 3 and 4. In addition, the rate was 39% (95% CI, 21-57) for a score greater than 4.
The performance of the new prognostic score was superior to the other indices, the researchers wrote.
“To the best of our knowledge, this is the largest reported series of patients with hepatic venous outflow obstruction which has evaluation outcomes post-interventional therapy and compared various prognostic indices,” the researchers wrote. “The results provide information about various distinct aspects of patients with hepatic venous outflow tract obstruction in the Indian subcontinent namely, clinical presentation, most prevalent site of block, results of endovascular interventions and prognostic parameters.” – by Will Offit
Disclosure: The researchers report no relevant financial disclosures.