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

Abstract

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.