25 Value of hvpg predicting 5-day treatment failure in acute variceal bleeding. Comparison with clinical variables

Aetiology of cirrhosis of the liver has an impact on survival predicted by the Model of End‐stage Liver Disease score

“…This seems to be the reason why we did not observe this difference in our previous studies [4,19]. A study had been performed in Spain, investigating predictors of 5‐day treatment failure of variceal bleeding, yielded ‘non‐alcoholic aetiology of cirrhosis’ as one of three independent predictors of survival [25]. In the original patient sample used to develop the MELD formula, the aetiology of liver disease had a significant impact on survival [10].…”

Measurement of Portal Pressure and Its Role in the Management of Chronic Liver Disease

“…20 mm Hg. 71 However, the risk of treatment failure could be predicted with similar accuracy using only clinical variables. Therefore, at the present time early measurements of HVPG in acute variceal bleeding cannot be recommended to select patients for more aggressive therapies.…”

Management of Acute Variceal Hemorrhage as a Model of Individualized Care for Patients With Cirrhosis

“…Because measuring HVPG within 24 hours from admission would not be feasible in most centers, particularly in a patient with acute variceal hemorrhage, the need for noninvasive predictors of death has become very important. In this respect, a retrospective study in which patients had been treated with the current standard of care (SOC: vasoactive drugs plus endoscopic therapy plus antibiotics), while confirming the cutoff HVPG of >20 mmHg in predicting treatment failure, showed a strong relationship between the presence of HVPG>20 mmHg and Child-Turcotte-Pugh (Child) class C (5).…”

“…This led to the landmark RCT of early TIPS for acute variceal hemorrhage (this time using covered stents) in high-risk patients defined by the investigators as those with a) Child C (excluding patients with a score of 14 and 15) and b) patients with Child B who had active bleeding at the time of endoscopy (6). While there was clear justification to include the first group (5), selection of the second group was not as clear. The study confirmed the results of the original trial (3) demonstrating significantly lower rates of treatment failure (4% vs. 45%) and death (12 vs. 39%) in patients randomized to TIPS compared to those randomized to SOC (Table) (6).…”