scholarly journals Impact of propofol sedation on the diagnostic accuracy of hepatic venous pressure gradient measurements in patients with cirrhosis

2021 ◽  
Author(s):  
Fahim Ebrahimi ◽  
David Semela ◽  
Markus Heim
Keyword(s):  
Portal Hypertension ◽  
Pressure Gradient ◽  
Hepatic Vein ◽  
Venous Pressure ◽  
Portal Pressure ◽  
Intraclass Correlation ◽  
Hepatic Venous Pressure Gradient ◽  
Propofol Sedation ◽  
Gradient Measurements ◽  
Awake Condition

Abstract Background Measurement of the hepatic venous pressure gradient (HVPG) is the gold standard to evaluate the presence and severity of portal hypertension. The procedure is generally safe and well tolerated, but nevertheless, some patients demand for sedation. However, it is unknown whether propofol sedation would impair the accuracy of portal pressure measurements. Methods This is a prospective observational cohort study including cirrhotic patients with suspected portal hypertension undergoing invasive measurement of HVPG. Measurements of HVPG were performed in awake condition as well as under sedation with propofol infusion. Results In total, 37 patients were included. Mean HVPG in awake condition was 15.9 mmHg (IQR 13–19) and during sedation 14.1 mmHg (IQR 12–17). While measures of free hepatic vein pressure (FHVP) were not altered after propofol sedation (p = 0.34), wedged hepatic vein pressure values (WHVP) decreased in an average by  2.05 mmHg (95% CI − 2.46 to − 1.16; p < 0.001) which was proportional to the magnitude of HVPG. In 31 out of 37 patients (83.8%), portal hypertension with HVPG ≥ 12 mmHg was found. Under sedation with propofol, two patients (5.4%) with borderline values would have been incorrectly classified as < 12 mmHg. After adjustment for the average difference of − 10%, all patients were correctly classified. Intraclass correlation coefficient between HVPG measurement in awake condition and under propofol sedation was 0.927 (95% CI 0.594–0.975). Conclusions Propofol sedation during HVPG measurements is generally safe, however it may lead to relevant alterations of HVPG readings.

Is it necessary to measure hepatic venous pressure gradient before liver resection in cirrhotic patients? A single center audit

2021 ◽  
pp. 1-10
Author(s):  
Hassaan Bari ◽  
Sana Amir Akbar ◽  
Faisal Hanif
Keyword(s):  
Hepatocellular Carcinoma ◽  
Portal Hypertension ◽  
Liver Resection ◽  
Pressure Gradient ◽  
Venous Pressure ◽  
Hepatic Venous Pressure Gradient ◽  
Research Centre ◽  
Duration Of Surgery ◽  
Cirrhotic Patients ◽  
Gradient Measurements

Abstract Objective: To determine whether routine preoperative hepatic venous pressure gradient measurements are necessary in child’s-A cirrhotic patients undergoing liver resection for hepatocellular carcinoma, and to assess immediate post-operative liver dysfunction and 30-day mortality in such cases. Methods: The 3-year audit was done at Shuakat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised data from January 1, 2015, to December 31, 2017, of all Child’s class “A” patients with hepatocellular carcinoma without any clinical signs of portal hypertension who had preoperative hepatic venous pressure gradient measurements done were. A proforma was used to collect the required data from patient files. Data was analysed using SPSS 21. Results: Of the 20 patients, 11(55%) were males. The overall mean age was 60.6+7.4 years. Only 2(10%) patients had raised hepatic venous pressure gradient. Of the total, 14(70%) patients underwent surgery. Mean duration of surgery was 222+82.5 minutes and mean hospital stay was 6.8+3.2 days. None of the patients had deranged prothrombin-time or bilirubin on postoperative day 5. Conclusion: The incidence of subclinical portal hypertension was very low.  Hepatic venous pressure gradient measurement can be avoided in early stage hepatocellular carcinoma for child’s A cirrhotic patients undergoing liver resection. Key Words: Portal hypertension, Hepatic venous pressure gradient, Continuous...

Mo1240 Spleen and Liver Volumes Are Strongly Correlated With Elevated Hepatic Venous Pressure Gradient in Patients With Non-Cirrhotic Portal Hypertension

2015 ◽  
Vol 148 (4) ◽  
pp. S-646-S-647
Author(s):  
Ohad Etzion ◽  
Akeem Adebogun ◽  
Jason Eccleston ◽  
Ahmed M. Gharib ◽  
David E. Kleiner ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Pressure Gradient ◽  
Venous Pressure ◽  
Hepatic Venous Pressure Gradient ◽  
Strongly Correlated

scholarly journals Acute and 14-Day Hepatic Venous Pressure Gradient Response to Carvedilol and Nebivolol in Patients With Liver Cirrhosis

Medicina ◽  
2013 ◽  
Vol 49 (11) ◽  
pp. 73 ◽  
Author(s):  
Vilma Silkauskaite ◽  
Jouzas Kupčinskas ◽  
Andrius Pranculis ◽  
Laimas Jonaitis ◽  
Vitalija Petrenkiene ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Pressure Gradient ◽  
Venous Pressure ◽  
Hepatic Venous Pressure Gradient ◽  
Alternative Drug

Background and Objective: Alternative drug therapies are needed for the treatment of portal hypertension.[...]

scholarly journals Single portal pressure measurement predicts survival in cirrhotic patients with recent bleeding

Gut ◽  
1999 ◽  
Vol 44 (2) ◽  
pp. 264-269 ◽  
Author(s):  
D Patch ◽  
A Armonis ◽  
C Sabin ◽  
K Christopoulou ◽  
L Greenslade ◽  
...  
Keyword(s):  
Pressure Gradient ◽  
Pressure Measurement ◽  
Predictive Value ◽  
Bleeding Episode ◽  
Venous Pressure ◽  
Portal Pressure ◽  
Alcoholic Cirrhosis ◽  
Hepatic Venous Pressure Gradient ◽  
Cox Regression Analysis ◽  
Cirrhotic Patients

BackgroundHeight of portal pressure correlates with severity of alcoholic cirrhosis. Portal pressure indices are not however used routinely as predictors of survival.AimsTo examine the clinical value of a single portal pressure measurement in predicting outcome in cirrhotic patients who have bled.MethodsA series of 105 cirrhotic patients who consecutively underwent hepatic venous pressure measurement were investigated. The main cause of cirrhosis was alcoholic (64.8%) and prior to admission all patients had bled from varices.ResultsDuring the follow up period (median 566 days, range 10–2555), 33 patients died, and 54 developed variceal haemorrhage. Applying Cox regression analysis, hepatic venous pressure gradient, bilirubin, prothrombin time, ascites, and previous long term endoscopic treatment were the only statistically independent predictors of survival, irrespective of cirrhotic aetiology. The predictive value of the pressure gradient was much higher if the measurement was taken within the first or the second week from the bleeding and there was no association after 15 days. A hepatic venous pressure gradient of at least 16 mm Hg appeared to identify patients with a greatly increased risk of dying.ConclusionsIndirectly measured portal pressure is an independent predictor of survival in patients with both alcoholic and non-alcoholic cirrhosis. In patients with a previous variceal bleeding episode this predictive value seems to be better if the measurement is taken within the first two weeks from the bleeding episode. A greater use of this technique is recommended for the prognostic assessment and management of patients with chronic liver disease.

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