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Hepatic venous pressure gradient predicts clinical decompensation in patients with compensated cirrhosis.
Gastroenterology. 2007 Aug; 133(2):481-8.G

Abstract

BACKGROUND AND AIMS

Our aim was to identify predictors of clinical decompensation (defined as the development of ascites, variceal hemorrhage [VH], or hepatic encephalopathy [HE]) in patients with compensated cirrhosis and with portal hypertension as determined by the hepatic venous pressure gradient (HVPG).

METHODS

We analyzed 213 patients with compensated cirrhosis and portal hypertension but without varices included in a trial evaluating the use of beta-blockers in preventing varices. All had baseline laboratory tests and HVPG. Patients were followed prospectively every 3 months until development of varices or VH or end of study. To have complete information, until study termination, about clinical decompensation, medical record review was done. Patients who underwent liver transplantation without decompensation were censored at transplantation. Cox regression models were developed to identify predictors of clinical decompensation. Receiver operating characteristic (ROC) curves were constructed to evaluate diagnostic capacity of HVPG.

RESULTS

Median follow-up time of 51.1 months. Sixty-two (29%) of 213 patients developed decompensation: 46 (21.6%) ascites, 6 (3%) VH, 17 (8%) HE. Ten patients received a transplant and 12 died without clinical decompensation. Median HVPG at baseline was 11 mm Hg (range, 6-25 mm Hg). On multivariate analysis, 3 predictors of decompensation were identified: HVPG (hazard ratio [HR], 1.11; 95% confidence interval [CI], 1.05-1.17), model of end-stage liver disease (MELD) (HR, 1.15; 95% CI, 1.03-1.29), and albumin (HR, 0.37; 95% CI, 0.22-0.62). Diagnostic capacity of HVPG was greater than for MELD or Child-Pugh score.

CONCLUSIONS

HVPG, MELD, and albumin independently predict clinical decompensation in patients with compensated cirrhosis. Patients with an HVPG <10 mm Hg have a 90% probability of not developing clinical decompensation in a median follow-up of 4 years.

Authors+Show Affiliations

Veterans Affairs CT Healthcare System, Yale University School of Medicine, West Haven, Connecticut 06516, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

17681169

Citation

Ripoll, Cristina, et al. "Hepatic Venous Pressure Gradient Predicts Clinical Decompensation in Patients With Compensated Cirrhosis." Gastroenterology, vol. 133, no. 2, 2007, pp. 481-8.
Ripoll C, Groszmann R, Garcia-Tsao G, et al. Hepatic venous pressure gradient predicts clinical decompensation in patients with compensated cirrhosis. Gastroenterology. 2007;133(2):481-8.
Ripoll, C., Groszmann, R., Garcia-Tsao, G., Grace, N., Burroughs, A., Planas, R., Escorsell, A., Garcia-Pagan, J. C., Makuch, R., Patch, D., Matloff, D. S., & Bosch, J. (2007). Hepatic venous pressure gradient predicts clinical decompensation in patients with compensated cirrhosis. Gastroenterology, 133(2), 481-8.
Ripoll C, et al. Hepatic Venous Pressure Gradient Predicts Clinical Decompensation in Patients With Compensated Cirrhosis. Gastroenterology. 2007;133(2):481-8. PubMed PMID: 17681169.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hepatic venous pressure gradient predicts clinical decompensation in patients with compensated cirrhosis. AU - Ripoll,Cristina, AU - Groszmann,Roberto, AU - Garcia-Tsao,Guadalupe, AU - Grace,Norman, AU - Burroughs,Andrew, AU - Planas,Ramon, AU - Escorsell,Angels, AU - Garcia-Pagan,Juan Carlos, AU - Makuch,Robert, AU - Patch,David, AU - Matloff,Daniel S, AU - Bosch,Jaime, AU - ,, Y1 - 2007/05/21/ PY - 2006/12/05/received PY - 2007/04/26/accepted PY - 2007/8/8/pubmed PY - 2007/9/7/medline PY - 2007/8/8/entrez SP - 481 EP - 8 JF - Gastroenterology JO - Gastroenterology VL - 133 IS - 2 N2 - BACKGROUND AND AIMS: Our aim was to identify predictors of clinical decompensation (defined as the development of ascites, variceal hemorrhage [VH], or hepatic encephalopathy [HE]) in patients with compensated cirrhosis and with portal hypertension as determined by the hepatic venous pressure gradient (HVPG). METHODS: We analyzed 213 patients with compensated cirrhosis and portal hypertension but without varices included in a trial evaluating the use of beta-blockers in preventing varices. All had baseline laboratory tests and HVPG. Patients were followed prospectively every 3 months until development of varices or VH or end of study. To have complete information, until study termination, about clinical decompensation, medical record review was done. Patients who underwent liver transplantation without decompensation were censored at transplantation. Cox regression models were developed to identify predictors of clinical decompensation. Receiver operating characteristic (ROC) curves were constructed to evaluate diagnostic capacity of HVPG. RESULTS: Median follow-up time of 51.1 months. Sixty-two (29%) of 213 patients developed decompensation: 46 (21.6%) ascites, 6 (3%) VH, 17 (8%) HE. Ten patients received a transplant and 12 died without clinical decompensation. Median HVPG at baseline was 11 mm Hg (range, 6-25 mm Hg). On multivariate analysis, 3 predictors of decompensation were identified: HVPG (hazard ratio [HR], 1.11; 95% confidence interval [CI], 1.05-1.17), model of end-stage liver disease (MELD) (HR, 1.15; 95% CI, 1.03-1.29), and albumin (HR, 0.37; 95% CI, 0.22-0.62). Diagnostic capacity of HVPG was greater than for MELD or Child-Pugh score. CONCLUSIONS: HVPG, MELD, and albumin independently predict clinical decompensation in patients with compensated cirrhosis. Patients with an HVPG <10 mm Hg have a 90% probability of not developing clinical decompensation in a median follow-up of 4 years. SN - 0016-5085 UR - https://www.unboundmedicine.com/medline/citation/17681169/Hepatic_venous_pressure_gradient_predicts_clinical_decompensation_in_patients_with_compensated_cirrhosis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5085(07)01006-2 DB - PRIME DP - Unbound Medicine ER -