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The prognostic value of HVPG-response to non-selective beta-blockers in patients with NASH cirrhosis and varices

Paternostro, Rafael, Becker, Jeannette, Hofer, Benedikt Silvester, Panagl, Vera, Schiffke, Helena, Simbrunner, Benedikt, Semmler, Georg, Schwabl, Philipp, Scheiner, Bernhard, Bucsics, Theresa, Bauer, David, Binter, Teresa, Trauner, Michael, Mandorfer, Mattias, Reiberger, Thomas·2022·Digestive and Liver Disease
DOI 10.1016/j.dld.2021.09.009
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Abstract

Background and aims Non-alcoholic steatohepatitis has become a leading cause of cirrhosis. The prognostic value of (HVPG)-guided NSBB prophylaxis remains to be investigated in the setting of NASH cirrhosis. Methods Patients with NASH cirrhosis and varices undergoing HVPG-guided NSBB therapy were included. HVPG-response to NSBBs was evaluated within a median 52 (IQR:28-71) days after baseline measurement. HVPG-Response was defined as a decrease of ≥10% from baseline or below Results Thirtyeight patients were included: Child-A/B:33(87%), Child-C:5(13%) median HVPG:19.7 ± 4.7 mmHg. 21(55.3%) patients achieved HVPG-response to NSBB. Presence of diabetes(aOR:0.16, p = 0.038) and arterial blood pressure (aOR:1.07, p = 0.044) were independently associated with NSBB-response. While NSBB-HVPG-responders showed fewer decompensations within 90 days (n = 1(5%) vs. n = 3(29%), p = 0.172), only Child-Pugh stage B/C (p = 0.001), MELD ≥ 15(p = 0.021) and HVPG ≥ 20 mmHg(p = 0.011) predicted the composite endpoint at 90 days. Similarly, after 2years of follow-up, only Child-Pugh stage (B:p = 0.001, C:p Conclusion HVPG-response to NSBB was achieved in 55.3% of NASH patients with varices and this seemed to protect from variceal bleeding. However, only baseline HVPG ≥ 20 mmHg, Child-Pugh stage B/C and MELD ≥ 15 were predictors of decompensation/death in patients with NASH cirrhosis and varices.

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Metadata

Authors
Paternostro, R., Becker, J., Hofer, B. S., Panagl, V., Schiffke, H., Simbrunner, B., Semmler, G., Schwabl, P., Scheiner, B., Bucsics, T., Bauer, D., Binter, T., Trauner, M., Mandorfer, M., & Reiberger, T.
ORCID
Reiberger, Thomas
Venue
Digestive and Liver Disease
Publisher
Elsevier BV
Published
2022-04
Volume
54
Issue
4
Pages
500-508
ISSN
1590-8658
DOI
10.1016/j.dld.2021.09.009
Cited by
17
References
3
Language
en
Licence
Funders
  • Bayer
  • Medizinische Universität Graz
  • Roche
  • Boehringer Ingelheim
  • Gilead Sciences
  • AbbVie
  • Meso Scale Diagnostics
  • Bristol-Myers Squibb

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