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Prognostic value of a single HVPG measurement and Doppler-ultrasound evaluation in patients with cirrhosis and portal hypertension

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

Background

In patients with cirrhosis the onset of clinically significant portal hypertension (CSPH; i.e., hepatic venous pressure gradient (HVPG) ≥ 10 mmHg) is associated with an increased risk of complications. However, most cirrhotic patients already have CSPH at presentation, and limited information is available on further risk stratification in this population. This study assessed the prognostic value of a single HVPG measurement and Doppler-ultrasound (US) evaluation in patients with cirrhosis and CSPH.

Methods

Eighty-six consecutive patients with cirrhosis (73% compensated) and untreated CSPH (mean HVPG 17.8 ± 5.1 mmHg) were included. All were studied by paired HVPG and US, and followed up for a minimum of 12 months (mean 28 ± 20 months).

Results

Sixteen (25.3%) patients developed a first decompensation, and 11.6% died on follow-up. HVPG (per 1 mmHg increase OR 1.22, 95% CI 1.05–1.40, p = 0.007) and bilirubin (per 1 mg/ml increase OR 2.42, 95% CI 0.93–6.26, p = 0.06) independently predicted first decompensation, and Model for End-Stage Liver Disease (MELD) score (per 1 point increase OR 1.24, 95% CI 1.03–1.51, p = 0.03) and HVPG (per 1 mmHg increase OR 1.08, 95% CI 1.01–1.26, p = 0.05) independently predicted mortality. The best HVPG cutoff predicting these events was 16 mmHg. Ultrasonographic parameters lacked independent predictive value. The ultrasonographic detection of abdominal collaterals had a high positive likelihood ratio (7.03, 95% CI 2.23–22.16) for the prediction of HVPG ≥ 16 mmHg, implying an increase of the probability of belonging to this higher-risk population from 58 to 91%.

Conclusions

HVPG holds an independent predictive value for first decompensation and death in patients with CSPH. The ultrasonographic detection of collaterals allows the non-invasive identification of patients with HVPG ≥ 16 mmHg, who are at higher risk.

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Abbreviations

HVPG:

Hepatic venous pressure gradient

CSPH:

Clinically significant portal hypertension

US:

Ultrasound

APC:

Abdominal porto-systemic collaterals

PUV:

Paraumbilical vein

LGV:

Left gastric vein

SR:

Spleno-renal shunt

SGV:

Short gastric veins

ROC:

Receiver operating curve

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Acknowledgments

The authors express their gratitude to Dr. Juan G. Abraldes for his suggestions for the statistical analysis of the data. We are indebted to Mrs. Assunta Galizia for her support in the Ultrasound Laboratory of Medicina Interna Zoli, and to the nursing and technologist staff of the interventional radiology units of Policlinico S. Orsola-Malpighi for the cooperation in the study. Dr. A. Berzigotti received financial support from a grant by the Department of Internal Medicine, Ageing and Nephrology, University of Bologna.

Conflict of interest

The authors have no conflicts of interest to declare.

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Authors and Affiliations

  1. Department of Internal Medicine, Ageing and Nephrology, University of Bologna, Policlinico S. Orsola-Malpighi, Via Albertoni 15, 40138, Bologna, Italy

    Annalisa Berzigotti, Valentina Rossi, Carolina Tiani, Lucia Pierpaoli, Paola Zappoli, Donatella Magalotti & Marco Zoli

  2. Department of Gastroenterology and Internal Medicine, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy

    Anna Riili, Carla Serra, Pietro Andreone, Maria Cristina Morelli & Rita Golfieri

  3. Department of Hematology, Oncology and Laboratory Medicine, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy

    Cristina Rossi

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  1. Annalisa Berzigotti
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  2. Valentina Rossi
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  3. Carolina Tiani
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Correspondence to Annalisa Berzigotti.

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Berzigotti, A., Rossi, V., Tiani, C. et al. Prognostic value of a single HVPG measurement and Doppler-ultrasound evaluation in patients with cirrhosis and portal hypertension. J Gastroenterol 46, 687–695 (2011). https://doi.org/10.1007/s00535-010-0360-z

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  • DOI: https://doi.org/10.1007/s00535-010-0360-z

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