{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T09:28:28Z","timestamp":1786699708303,"version":"build-2736575974"},"reference-count":20,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: In cirrhotic patients, guidelines generally recommend maintaining mean arterial pressure (MAP) \u2265 65 mmHg, but the prognostic impact of MAP in transplant candidates is unclear. This study aimed to evaluate the association between MAP and waitlist mortality and cirrhosis-related complications in patients listed for liver transplantation. Methods: We conducted a retrospective cohort study of 103 adults (age \u2265 18 years) with cirrhosis listed for liver transplantation (MELD 20\u201324) at a single center (2019\u20132023). Patients with hepatocellular carcinoma were excluded. The primary outcome was death on the transplant waitlist (n = 9 events). Logistic regression was used to assess the association of MAP (per 1 mmHg) with mortality. Continuous variables were compared using the t-test, and categorical variables were compared using the chi-square test; p &lt; 0.05 was considered significant. Results: Mean MAP at listing was significantly higher in survivors than non-survivors (83.2 \u00b1 9.4 vs. 76.9 \u00b1 8.7 mmHg; p = 0.04). In logistic regression, higher MAP was associated with lower odds of waitlist death (unadjusted odds ratio [OR] per 1 mmHg increase = 0.94; 95% confidence interval [CI] 0.89\u20130.99; p = 0.041). Subgroup analysis showed a significant inverse association between MAP and hepatorenal syndrome (HRS) (OR per 1 mmHg = 0.94; 95% CI 0.89\u20130.98; p = 0.011), whereas MAP was not significantly associated with hepatic encephalopathy, ascites, or variceal bleeding (all p &gt; 0.2). Conclusions: Among the cirrhotic patients listed for transplantation, lower MAP at baseline is associated with waitlist mortality and hepatorenal syndrome. These findings should be interpreted cautiously given the small number of events and require validation in larger cohorts.<\/jats:p>","DOI":"10.3390\/jcm15166292","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T08:08:29Z","timestamp":1786694909000},"page":"6292","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of Mean Arterial Pressure (MAP) with Mortality in Patients with Liver Cirrhosis Awaiting Transplantation"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-6719-1396","authenticated-orcid":false,"given":"Yazan","family":"Omari","sequence":"first","affiliation":[{"name":"Henry Ford Providence Hospital, Southfield, MI 48075, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Alomari","sequence":"additional","affiliation":[{"name":"Henry Ford Health, Detroit, MI 48202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9294-6297","authenticated-orcid":false,"given":"Ismail","family":"Althunibat","sequence":"additional","affiliation":[{"name":"Henry Ford Health, Detroit, MI 48202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulmalik","family":"Saleem","sequence":"additional","affiliation":[{"name":"Henry Ford Health, Detroit, MI 48202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thai Hau","family":"Koo","sequence":"additional","affiliation":[{"name":"Henry Ford Health, Detroit, MI 48202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yara","family":"Dababneh","sequence":"additional","affiliation":[{"name":"Henry Ford Health, Detroit, MI 48202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Jomaa","sequence":"additional","affiliation":[{"name":"Henry Ford Health, Detroit, MI 48202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Mo","sequence":"additional","affiliation":[{"name":"Henry Ford Health, Detroit, MI 48202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Abdulraheem","sequence":"additional","affiliation":[{"name":"Henry Ford Health, Detroit, MI 48202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8108-7408","authenticated-orcid":false,"given":"Syed-Mohammed","family":"Jafri","sequence":"additional","affiliation":[{"name":"Henry Ford Health, Detroit, MI 48202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1097\/LVT.0000000000000359","article-title":"Outpatient Mean Arterial Pressure: A Potentially Modifiable Risk for Acute Kidney Injury and Death Among Patients With Cirrhosis","volume":"30","author":"Cullaro","year":"2024","journal-title":"Liver Transplant."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1016\/S0140-6736(21)01374-X","article-title":"Liver Cirrhosis","volume":"398","author":"Krag","year":"2021","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1002\/hep.31884","article-title":"Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases","volume":"74","author":"Biggins","year":"2021","journal-title":"Hepatology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1111\/apt.15439","article-title":"Systemic arterial blood pressure determines the therapeutic window of non-selective beta blockers in decompensated cirrhosis","volume":"50","author":"Tergast","year":"2019","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"866","DOI":"10.1016\/j.jhep.2022.12.005","article-title":"Beta-Blockers in the Era of Precision Medicine in Patients With Cirrhosis","volume":"78","author":"Albillos","year":"2023","journal-title":"J. Hepatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1355","DOI":"10.1016\/j.jhep.2020.12.003","article-title":"Validating a Novel Score Based on Interaction Between ACLF Grade and MELD Score to Predict Waitlist Mortality","volume":"74","author":"Abdallah","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1056\/NEJMra1504367","article-title":"Treatment of Patients with Cirrhosis","volume":"375","author":"Ge","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Doerken, S., Avalos, M., Lagarde, E., and Schumacher, M. (2019). Penalized Logistic Regression With Low Prevalence Exposures Beyond High Dimensional Settings. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0217057"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Rahman, M.S., and Sultana, M. (2017). Performance of Firth-and logF-type Penalized Methods in Risk Prediction for Small or Sparse Binary Data. BMC Med. Res. Methodol., 17.","DOI":"10.1186\/s12874-017-0313-9"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2302","DOI":"10.1002\/sim.7273","article-title":"Firth\u2019s Logistic Regression With Rare Events: Accurate Effect Estimates and Predictions?","volume":"36","author":"Puhr","year":"2017","journal-title":"Stat. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e68247","DOI":"10.2196\/68247","article-title":"Forecasting Waitlist Trajectories for Patients With Metabolic Dysfunction-Associated Steatohepatitis Cirrhosis: A Neural Network Competing Risk Analysis","volume":"28","author":"Punchhi","year":"2026","journal-title":"J. Med. Internet Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e170","DOI":"10.1097\/TP.0000000000004957","article-title":"Waitlist Outcomes for Exception and Non-Exception Liver Transplant Candidates in the United States Following Implementation of the Median MELD at Transplant (MMaT)\/250-mile Policy","volume":"108","author":"Ishaque","year":"2024","journal-title":"Transplantation"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e13837","DOI":"10.1111\/ctr.13837","article-title":"Liver transplant waitlist outcomes in alcoholic hepatitis compared with other liver diseases: An analysis of UNOS registry","volume":"34","author":"Kitajima","year":"2020","journal-title":"Clin. Transplant."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1632350","DOI":"10.1155\/2020\/1632350","article-title":"A Comparative Study of the Bias Correction Methods for Differential Item Functioning Analysis in Logistic Regression with Rare Events Data","volume":"2020","author":"Faghih","year":"2020","journal-title":"BioMed Res. Int."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"\u0160inkovec, H., Geroldinger, A., and Heinze, G. (2019). Bring More Data!-a Good Advice? Removing Separation in Logistic Regression by Increasing Sample Size. Int. J. Environ. Res. Public Health, 16.","DOI":"10.20944\/preprints201910.0321.v1"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3133","DOI":"10.1002\/sim.6537","article-title":"Penalization, Bias Reduction, and Default Priors in Logistic and Related Categorical and Survival Regressions","volume":"34","author":"Greenland","year":"2015","journal-title":"Stat. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1002\/hep.21025","article-title":"Deaths on the Liver Transplant Waiting List: An Analysis of Competing Risks","volume":"43","author":"Kim","year":"2006","journal-title":"Hepatology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e251759","DOI":"10.1001\/jamanetworkopen.2025.1759","article-title":"US Population Size and Outcomes of Adults on Liver Transplant Waiting Lists","volume":"8","author":"Tanaka","year":"2025","journal-title":"JAMA Netw. Open"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1016\/j.jclinepi.2010.11.012","article-title":"Performance of Logistic Regression Modeling: Beyond the Number of Events Per Variable, the Role of Data Structure","volume":"64","author":"Courvoisier","year":"2011","journal-title":"J. Clin. Epidemiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2455","DOI":"10.1177\/0962280218784726","article-title":"Sample Size for Binary Logistic Prediction Models: Beyond Events Per Variable Criteria","volume":"28","author":"Moons","year":"2019","journal-title":"Stat. Methods Med. Res."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6292\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T08:34:58Z","timestamp":1786696498000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6292"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,14]]},"references-count":20,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcm15166292"],"URL":"https:\/\/doi.org\/10.3390\/jcm15166292","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,14]]}}}