Portal Venous Pressure as a Predictor of Mortality in Child’s A Cirrhotic Patients Undergoing Elective Surgery: A Prospective Study

Mohamed El-Ghobary; Ahmed Abdallah Salman; Hossam El-Din Shaaban; Mohamed Saber Mostafa; Mohamed Sabry Tourky; Ossama Ramzy Youssef; Mahmoud Gouda Omar

doi:10.3889/oamjms.2020.3373

Authors

Mohamed El-Ghobary Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
Ahmed Abdallah Salman Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
Hossam El-Din Shaaban Department of Gastroenterology, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
Mohamed Saber Mostafa Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
Mohamed Sabry Tourky Department of General Surgery, Alawi Tunsi Hospital, Mecca, Saudi Arabia
Ossama Ramzy Youssef Department of Anaesthesia and Intensive Care, Ain Shams University, Cairo, Egypt
Mahmoud Gouda Omar Department of Internal Medicine, Faculty of medicine, Cairo University, Cairo, Egypt

DOI:

https://doi.org/10.3889/oamjms.2020.3373

Keywords:

Cirrhosis, Portal venous pressure, Mortality

Abstract

BACKGROUND: Recently, portal venous pressure (PVP) exhibited high sensitivity and specificity in anticipating death in cirrhotic cases submitted to emergency operations.

AIM: The current prospective work aimed to evaluate the utility of PVP in predicting 1st month post-operative death in Child’s A cirrhotic cases who underwent elective operations.

METHODS: One-hundred and twenty cirrhotic cases that were planned to undergo elective surgery were enrolled in the current prospective work. The intraoperative (I.O) PVP and central venous pressure (CVP) were measured. The statistical analysis was performed using the SPSS version 22.0. The receiver operative curve was plotted to measure the predictive value of PVP. Multivariate analysis was done using logistic regression method for the significant variables impacting mortality on univariate analysis.

RESULTS: Twenty-nine patients died in the current work. Patients who survived had statistically considerably lower PVP than patients who died (8.2 ± 1.5 vs. 12.5 ± 1.6 mmHg, respectively, p < 0.001). Similarly, patients who died had significantly higher I.O CVP (p < 0.001), body mass index (p < 0.001), and were more likely to have model for end-stage liver disease score between 9 and 16 (p = 0.003). At a cutoff value ≥10.5 mmHg, the PVP had a sensitivity of 82.8% and specificity of 93.4% for the prediction of mortality. The logistic regression analysis showed that only PVP (odds ratio [OR] =3.1, 95% confidence interval [CI] 1.25–7.5) and CVP (OR = 2.8, 95% CI 1.2–6.5) were the only independent predictors of mortality.

CONCLUSION: PVP is a significant predictor of death in Child’s A cirrhotic cases submitted to elective operations.

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