Tags

Type your tag names separated by a space and hit enter

Clinical significance of worsening portal hypertension during long-term medical treatment in patients with cirrhosis who had been classified as early good-responders on haemodynamic criteria.
J Hepatol. 2010 Jan; 52(1):45-53.JH

Abstract

BACKGROUND & AIMS

It is established that cirrhotic patients who respond to beta-blockers by lowering their hepatic venous pressure gradient (HVPG) to < or =12 mmHg or by > or =20% of the baseline values are protected from bleeding. However, it is not known whether the effect remains unchanged over the treatment period.

METHODS

A group of 24 patients with cirrhosis and oesophageal varices, treated with beta-blockers+/-nitrates, good-responders on haemodynamic criteria, were followed for up to 76 months with sequential HVPG measurements. Another group of 16 patients was used for validation.

RESULTS

HVPG worsened in 10 of the 24 patients during follow-up. Changes in HVPG correlated to concomitant changes in liver function parameters. Variceal bleeding occurred in four of the 10 patients whose HVPG had worsened (bleed; 3-21 months after the measured increase in HVPG) and in none of those with stable HVPG (p=0.02). Patients with increased HVPG also had shorter survival (p=0.05). Worsening of HVPG was an independent predictor of death, additive to Child-Pugh or MELD scores, in a time-dependent Cox's regression analysis. This relationship was confirmed in the validation group.

CONCLUSIONS

Worsening HVPG during follow-up in patients who had initially been good-responders to medical treatment is related to worsening in hepatic function. The maintenance of a good haemodynamic response to medical treatment of portal hypertension is an excellent predictor of outcome in these patients.

Authors+Show Affiliations

Department of Clinical and Experimental Medicine, University of Padua, Italy. carlo.merkel@unipd.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19914730

Citation

Merkel, Carlo, et al. "Clinical Significance of Worsening Portal Hypertension During Long-term Medical Treatment in Patients With Cirrhosis Who Had Been Classified as Early Good-responders On Haemodynamic Criteria." Journal of Hepatology, vol. 52, no. 1, 2010, pp. 45-53.
Merkel C, Bolognesi M, Berzigotti A, et al. Clinical significance of worsening portal hypertension during long-term medical treatment in patients with cirrhosis who had been classified as early good-responders on haemodynamic criteria. J Hepatol. 2010;52(1):45-53.
Merkel, C., Bolognesi, M., Berzigotti, A., Amodio, P., Cavasin, L., Casarotto, I. M., Zoli, M., & Gatta, A. (2010). Clinical significance of worsening portal hypertension during long-term medical treatment in patients with cirrhosis who had been classified as early good-responders on haemodynamic criteria. Journal of Hepatology, 52(1), 45-53. https://doi.org/10.1016/j.jhep.2009.10.014
Merkel C, et al. Clinical Significance of Worsening Portal Hypertension During Long-term Medical Treatment in Patients With Cirrhosis Who Had Been Classified as Early Good-responders On Haemodynamic Criteria. J Hepatol. 2010;52(1):45-53. PubMed PMID: 19914730.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical significance of worsening portal hypertension during long-term medical treatment in patients with cirrhosis who had been classified as early good-responders on haemodynamic criteria. AU - Merkel,Carlo, AU - Bolognesi,Massimo, AU - Berzigotti,Annalisa, AU - Amodio,Piero, AU - Cavasin,Lucia, AU - Casarotto,Ilaria Maria, AU - Zoli,Marco, AU - Gatta,Angelo, Y1 - 2009/10/23/ PY - 2009/01/12/received PY - 2009/07/23/revised PY - 2009/07/30/accepted PY - 2009/11/17/entrez PY - 2009/11/17/pubmed PY - 2010/9/18/medline SP - 45 EP - 53 JF - Journal of hepatology JO - J Hepatol VL - 52 IS - 1 N2 - BACKGROUND & AIMS: It is established that cirrhotic patients who respond to beta-blockers by lowering their hepatic venous pressure gradient (HVPG) to < or =12 mmHg or by > or =20% of the baseline values are protected from bleeding. However, it is not known whether the effect remains unchanged over the treatment period. METHODS: A group of 24 patients with cirrhosis and oesophageal varices, treated with beta-blockers+/-nitrates, good-responders on haemodynamic criteria, were followed for up to 76 months with sequential HVPG measurements. Another group of 16 patients was used for validation. RESULTS: HVPG worsened in 10 of the 24 patients during follow-up. Changes in HVPG correlated to concomitant changes in liver function parameters. Variceal bleeding occurred in four of the 10 patients whose HVPG had worsened (bleed; 3-21 months after the measured increase in HVPG) and in none of those with stable HVPG (p=0.02). Patients with increased HVPG also had shorter survival (p=0.05). Worsening of HVPG was an independent predictor of death, additive to Child-Pugh or MELD scores, in a time-dependent Cox's regression analysis. This relationship was confirmed in the validation group. CONCLUSIONS: Worsening HVPG during follow-up in patients who had initially been good-responders to medical treatment is related to worsening in hepatic function. The maintenance of a good haemodynamic response to medical treatment of portal hypertension is an excellent predictor of outcome in these patients. SN - 1600-0641 UR - https://www.unboundmedicine.com/medline/citation/19914730/Clinical_significance_of_worsening_portal_hypertension_during_long_term_medical_treatment_in_patients_with_cirrhosis_who_had_been_classified_as_early_good_responders_on_haemodynamic_criteria_ DB - PRIME DP - Unbound Medicine ER -