Portal venous pressure in non-cirrhotic bilharzial patients undergoing elective splenectomy, can it affect mortality? A prospective study

Background and study aims: To evaluate the impact of intra- operatively measured portal vein pressure (PVP) on mortality in non-cirrhotic bilharzial patients undergoing splenectomy. Methods: The present study is a prospective study that was conducted in Egypt from April 2014 to April 2018. Adult patients with non-cirrhotic bilharziasis who were scheduled to undergo splenectomy were included. Studied cases were divided into a survival cohort and a non-survival cohort. The main objective was the correlation between the incidence of mortality and intraoperative PVP. Results: The present work comprised 130 cases with a mean age of 51.8 ± 6.4 years old. The in-hospital mortality rate was 22.3%, with sepsis as a major cause of death (37.9%). In term of the association between preoperative variables and mortality, survivors had statistically significant lower portal vein diameter (13.6 ± 1.8 versus 15.2 ± 1.8mm; p<0.001) and higher portal vein velocity (14.2 ± 1.8 versus 10.4 ± 2.3 cm/sec; p<0.001) than non- survivors. The survived patients had significantly lower PVP (13.9 ± 1.1 versus 17.7 ± 2.7; p <0.001). A cut-off value of ≥14.5 mmHg, the PVP yielded a sensitivity of 86.2% and a specificity of 69% for the prediction of mortality. The association analysis showed a statistically significant association between mortality and postoperative liver function parameters. Conclusions: High intraoperative PVP is linked to early postoperative death in non-cirrhotic cases undergoing splenectomy. Our study showed that PVP > 14.5mmHg was an independent predictor of death and showed good diagnostic performance for the detection of early postoperative mortality.

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A prospective study of the effect of terlipressin on portal vein pressure and clinical outcomes after hepatectomy: A pilot study

Surgery ◽

10.1016/j.surg.2020.01.013 ◽

2020 ◽

Vol 167 (6) ◽

pp. 926-932 ◽

Cited By ~ 1

Author(s):

Xiao-Long Li ◽

Xiao-Dong Zhu ◽

Nan Xiao ◽

Xue-Feng Liu ◽

Bin Xu ◽

...

Keyword(s):

Pilot Study ◽

Portal Vein ◽

Prospective Study ◽

Clinical Outcomes ◽

Portal Vein Pressure ◽

A Prospective Study

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Increase of portal vein pressure gradient after hepatectomy predicts post-operative liver dysfunction

10.21203/rs.3.rs-24108/v1 ◽

2020 ◽

Author(s):

Nan Xiao ◽

Xiao-long Li ◽

Xiao-dong Zhu ◽

Cheng huang ◽

Ying-hao Shen ◽

...

Keyword(s):

Liver Resection ◽

Portal Vein ◽

Pressure Gradient ◽

Venous Pressure ◽

Multivariable Analysis ◽

Central Vein ◽

Roc Curve Analysis ◽

Portal Vein Pressure ◽

Mortality And Morbidity ◽

The Impact

Abstract Background Post-hepatectomy liver failure (PHLF) is an important cause of mortality and morbidity. Whether Child–Pugh A Patients with varying degrees of cirrhosis are good candidates for hepatectomy is disputed. The purpose of this study was to analyse the impact of portal venous pressure gradient (PVPG) variation during surgery on PHLF. Methods PVPG, the pressure gradient between the portal vein and central vein, was measured in consecutive patients before and after liver resection. The optimal cut-off of PVGP to predict PHLF was determined by receiver operating characteristic (ROC) curve analysis. Risk factors for PHLF were subjected to univariable and multivariable analysis. Results Sixty Child-Pugh A patients were recruited. The mean PVPG was increased from 5.17 ± 4.78 millimeters of Mercury (mmHg) to 6.37 ± 4.44 mmHg after liver resection. The optimal cut-off value of PVPG increments to predict PHLF was 1.5 mmHg. Multivariable analysis showed prothrombin time (PT), post-hepatectomy PVPG increments of 1.5 mmHg or greater, and resected liver segments of 3 or more to be independent predictors of PHLF. Conclusions Acute PVPG increase after hepatectomy is associated with a higher risk of PHLF in Child-Pugh A patients.

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Increase of Portal Vein Pressure Gradient After Hepatectomy Predicts Post-operative Liver Dysfunction

Surgical Innovation ◽

10.1177/15533506211018620 ◽

2021 ◽

pp. 155335062110186

Author(s):

Nan Xiao ◽

Xiao-Long Li ◽

Xiao-Dong Zhu ◽

Cheng Huang ◽

Ying-Hao Shen ◽

...

Keyword(s):

Liver Resection ◽

Portal Vein ◽

Pressure Gradient ◽

Characteristic Curve ◽

Venous Pressure ◽

Multivariable Analysis ◽

Central Vein ◽

Optimal Cutoff ◽

Portal Vein Pressure ◽

The Impact

Background. Post-hepatectomy liver failure (PHLF) is an important cause of mortality and morbidity. Whether Child–Pugh A patients with varying degrees of cirrhosis are good candidates for hepatectomy is disputed. The purpose of this study was to analyze the impact of portal venous pressure gradient (PVPG) variation during surgery on PHLF. Methods. PVPG, the pressure gradient between the portal vein and central vein, was measured in consecutive patients before and after liver resection. The optimal cutoff of PVPG to predict PHLF was determined by receiver operating characteristic curve analysis. Risk factors for PHLF were subjected to univariate and multivariable analysis. Results. Sixty Child–Pugh A patients were recruited. The mean PVPG was increased from 5.17 ± 4.78 mm of mercury (mmHg) to 6.37 ± 4.44 mmHg after liver resection. The optimal cutoff value of PVPG increments to predict PHLF was 1.5 mmHg. Multivariable analysis showed prothrombin time (PT), post-hepatectomy PVPG increments of 1.5 mmHg or greater, and resected liver segments of 3 or more to be independent predictors of PHLF. Conclusions. Acute PVPG increase after hepatectomy is associated with a higher risk of PHLF in Child–Pugh A patients.

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