Hepatic venous pressure gradient can predict the development of hepatocellular carcinoma and hyponatremia in decompensated alcoholic cirrhosis

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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T06.01.6 SPLEEN STIFFNESS MEASUREMENT PREDICTS THE DEVELOPMENT OF PRIMARY HEPATOCELLULAR CARCINOMA BETTER THAN HEPATIC VENOUS PRESSURE GRADIENT

Digestive and Liver Disease ◽

10.1016/s1590-8658(20)30851-3 ◽

2020 ◽

Vol 52 ◽

pp. S160

Author(s):

G. Marasco ◽

A. Colecchia ◽

F. Ravaioli ◽

E. Dajti ◽

M. Renzulli ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Pressure Gradient ◽

Venous Pressure ◽

Primary Hepatocellular Carcinoma ◽

Hepatic Venous Pressure Gradient ◽

Stiffness Measurement ◽

Spleen Stiffness ◽

Better Than

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Value of hepatic venous pressure gradient measurement before liver resection for hepatocellular carcinoma

British Journal of Surgery ◽

10.1002/bjs.7672 ◽

2011 ◽

Vol 98 (12) ◽

pp. 1752-1758 ◽

Cited By ~ 31

Author(s):

S. Stremitzer ◽

D. Tamandl ◽

K. Kaczirek ◽

J. Maresch ◽

B. Abbasov ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Resection ◽

Pressure Gradient ◽

Venous Pressure ◽

Hepatic Venous Pressure Gradient ◽

Gradient Measurement

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The cut-off value of transient elastography to the value of hepatic venous pressure gradient in alcoholic cirrhosis

Clinical and Molecular Hepatology ◽

10.3350/cmh.2020.0171 ◽

2021 ◽

Vol 27 (1) ◽

pp. 197-206

Author(s):

Se Ri Ryu ◽

Jeong-Ju Yoo ◽

Seong Hee Kang ◽

Soung Won Jeong ◽

Moon Young Kim ◽

...

Keyword(s):

Portal Hypertension ◽

Pressure Gradient ◽

Transient Elastography ◽

Venous Pressure ◽

Liver Stiffness ◽

Alcoholic Cirrhosis ◽

Hepatic Venous Pressure Gradient ◽

Ratio Score ◽

Noninvasive Method ◽

Cutoff Value

Background/Aims: The hepatic venous pressure gradient (HVPG) reflects portal hypertension, but its measurement is invasive. Transient elastography (TE) is a noninvasive method for evaluating liver stiffness (LS). We investigated the correlation between the value of LS, LS to platelet ratio (LPR), LS-spleen diameter-to-platelet ratio score (LSPS) and HVPG according to the etiology of cirrhosis, especially focused on alcoholic cirrhosis.Methods: Between January 2008 and March 2017, 556 patients who underwent HVPG and TE were consecutively enrolled. We evaluated LS, LPR, and LSPS according to the etiology of cirrhosis and analyzed their correlations with HVPG.Results: The LS value was higher in patients with alcoholic cirrhosis than viral cirrhosis based on the HVPG (43.5 vs. 32.0 kPa, P<0.001). There were no significant differences in the LPR or LSPS between alcoholic and viral cirrhosis groups, and the areas under the curves for the LPR and LSPS in subgroups according to HVPG levels were not superior to that for LS. In alcoholic cirrhosis, the LS cutoff value for predicting an HVPG ≥10 mmHg was 32.2 kPa with positive predictive value (PPV) of 94.5% and 36.6 kPa for HVPG ≥12 mmHg with PPV of 91.0%.Conclusions: The LS cutoff value should be determined separately for patients with alcoholic and viral cirrhosis. In alcoholic cirrhosis, the LS cutoff values were 32.2 and 36.6 kPa for predicting an HVPG ≥10 and ≥12 mmHg, respectively. However, there were no significant differences in the LPR or LSPS between alcoholic and viral cirrhosis groups.

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