+ Site Statistics
References:
54,258,434
Abstracts:
29,560,870
PMIDs:
28,072,757
+ Search Articles
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ PDF Full Text
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Translate
+ Recently Requested

Hepatic venous pressure gradient and prognosis in patients with acute variceal bleeding treated with pharmacologic and endoscopic therapy



Hepatic venous pressure gradient and prognosis in patients with acute variceal bleeding treated with pharmacologic and endoscopic therapy



Journal of Hepatology 48(2): 229-236



In acute variceal bleeding (AVB) hepatic venous pressure gradient (HVPG) is associated with prognosis. However, this has not been studied in patients receiving the currently recommended therapy. We evaluate here the performance of early HVPG measurement as a predictor of treatment failure in patients with acute variceal bleeding managed with the current standard treatment and whether clinical variables might be of similar predictive accuracy. We included 117 patients with AVB in whom HVPG was measured within 48 h of admission. The main endpoint was 5-day failure, a composite of uncontrolled bleeding, early rebleeding or death within 5 days. Eighteen patients (15%) had 5-day failure. Multivariate analysis identified three variables independently associated with 5-day failure: HVPG 20, systolic blood pressure at admission <100 mmHg and non-alcoholic cause of cirrhosis. The discriminative capacity of this model was good (c statistic: 0.79). When only clinical variables were included in the analysis, Child-Pugh class, systolic blood pressure at admission and etiology were the independent predictors. This model had also a good discriminative ability (c statistic: 0.80). HVPG independently predicts short-term prognosis in patients with acute variceal bleeding treated with pharmacologic and endoscopic therapy, but similar predictive accuracy can be achieved using only simple clinical variables that have universal applicability.

(PDF emailed within 0-6 h: $19.90)

Accession: 021126904

Download citation: RISBibTeXText

PMID: 18093686

DOI: 10.1016/j.jhep.2007.10.008


Related references

Relationships between the time-course of hepatic venous pressure gradient and the response to endoscopic treatment of varices in cirrhotic patients with acute variceal bleeding. Hepatology 34(4 Pt 2): 535A, October, 2001

Monitoring hepatic venous pressure gradient in patients on beta blocker therapy for primary prophylaxis of variceal bleeding is cost-effective. Gastroenterology 112(4 SUPPL ): A1355, 1997

Hepatic venous pressure gradient measurement before TIPS for acute variceal bleeding. World Journal of Gastroenterology 20(23): 7523-7524, 2015

Measurement of hepatic venous pressure gradient in patients with active variceal bleeding. Hepatology 41(2): 406-7; Author Reply 407, 2005

Treatment of acute variceal bleeding by the hepatic venous pressure gradient Preliminary results of a randomized trial. Hepatology 30(4 PART 2): 220A, 1999

Hepatic venous pressure gradient measurement in patients with liver cirrhosis: a correlation with disease severity and variceal bleeding. Medicina 45(1): 8-13, 2009

Hepatic venous pressure gradient in cirrhosis: role in variceal bleeding, non-bleeding complications and outcome. Asian Journal of Surgery 29(3): 113-119, 2006

Hepatic Venous Pressure Gradient Measurement in Bangladeshi Cirrhotic Patients: A Correlation with Child's Status, Variceal Size, and Bleeding. Euroasian Journal of Hepato-Gastroenterology 7(2): 142-145, 2017

Cost-effectiveness of hepatic venous pressure gradient measurements for prophylaxis of variceal re-bleeding. Alimentary Pharmacology & Therapeutics 19(5): 571-581, 2004

The cost effectiveness of hepatic venous pressure gradient monitoring in prevention of recurrent variceal bleeding. Gastroenterology 122(4 Suppl 1): A 79, April, 2002

Clinical application of hepatic venous pressure gradient to predict early bleeding after esophageal variceal ligation. Zhonghua Gan Zang Bing Za Zhi 23(1): 50-54, 2015

A cost-effectiveness study of hepatic venous pressure gradient measurement in the secondary prevention of variceal bleeding. Revista Espanola de Enfermedades Digestivas 100(7): 416-422, 2008

Should we routinely measure portal pressure in patients with cirrhosis, using hepatic venous pressure gradient (HVPG) as a guide for prophylaxis and therapy of bleeding and rebleeding? No. European Journal of Internal Medicine 22(1): 5-7, 2011

Endoscopic variceal ligation vs endoscopic variceal sclerotherapy in the management of patients with advanced hepatocellular carcinoma and acute esophageal variceal bleeding. Gastroenterology. 104(4 Suppl.): A943, 1993

Portal venous pressure and portal venous pressure gradient are similar in patients with refractory ascites and recurrent variceal bleeding. Gastroenterology 114(4 PART 2): A1361, April 15, 1998