Hepatic Venous Pressure Gradient Predicts Further Decompensation in Cirrhosis Patients with Acute Esophageal Variceal Bleeding

Abstract

Background: The role of hepatic venous pressure gradient (HVPG) in predicting further decompensation in cirrhosis patients with acute variceal bleeding (AVB) is not known. We aimed to evaluate the role of HVPG in predicting further decompensation in cirrhosis patients with AVB Methods: In this prospective study, 145 patients with cirrhosis with esophageal or gastric AVB were included. HVPG was measured on the day of the AVB. Decompensating events occurring after 42-days of AVB were considered further decompensation. Results: The median age of the study cohort was 44 years; 88.3% males. The predominant etiology of cirrhosis was alcohol (46.2%). Overall, 40 (27.6%) patients developed further decompensation during median follow-up of 296 days following AVB. Gastro intestinal bleeding n = 27 (18.6%) and new-onset/worsening ascites n = 20 (13.8%) were the most common decompensating events. According to the multivariate model, HVPG was an independent predictor of any further decompensation in esophageal AVB patients but not in gastric variceal bleeding patients. HVPG cut-off of ≥16 mmHg predicted further decompensation in the esophageal AVB. However, HVPG was not an independent predictor of mortality. Conclusion: HVPG measured during an episode of acute variceal hemorrhage from esophageal varices predicts further decompensating events in cirrhosis patients.

Analysis of Factors Influencing Prognosis and Assessment of 60 Cases of Decompensated Cirrhotic Patients with Portal Hypertension

“…Elevated portal vein pressure correlates with a greater degree of esophageal varices. 10–12 The Child-Pugh score is commonly used in clinical practice to assess liver function, 13 , 14 with higher scores indicating worse liver function. Research by Zheng Jin Liu 15 has shown that HVPG values in patients classified as Child-Pugh C are higher than those in class B.…”

“…Elevated portal vein pressure correlates with a greater degree of esophageal varices. [10][11][12] The Child-Pugh score is commonly used in clinical practice to assess liver function, 13,14 According to the consensus recommendations, an HVPG level ≥ 16 mmHg indicates a significant risk of complications related to portal hypertension3. In this study, compensated cirrhotic patients with portal hypertension were divided into two groups: those with HVPG < 16 mmHg and those with HVPG ≥ 16 mmHg.…”

Case report: Management of liver cancer complicated by gastric varices rupture and bleeding: transjugular intrahepatic portosystemic shunt utilizing the mesenteric venous pathway

“…Patients with decompensated liver cirrhosis and malignant liver tumors, particularly those experiencing gastric variceal bleeding, face a poor prognosis. As discussed in the introduction, gastric variceal bleeding is a leading cause of mortality, primarily due to recurrent bleeding and liver failure ( 17 ). The coexistence of HCC, portal hypertension, and bleeding gastric varices complicates TIPS procedures.…”