Hepatic Venous Pressure Gradient Predicts Clinical Decompensation in Patients With Compensated Cirrhosis
Abstract
Background and aims Our aim was to identify predictors of clinical decompensation (defined as the development of ascites, variceal hemorrhage [VH], or hepatic encephalopathy [HE]) in patients with compensated cirrhosis and with portal hypertension as determined by the hepatic venous pressure gradient (HVPG). Methods We analyzed 213 patients with compensated cirrhosis and portal hypertension but without varices included in a trial evaluating the use of beta-blockers in preventing varices. All had baseline laboratory tests and HVPG. Patients were followed prospectively every 3 months until development of varices or VH or end of study. To have complete information, until study termination, about clinical decompensation, medical record review was done. Patients who underwent liver transplantation without decompensation were censored at transplantation. Cox regression models were developed to identify predictors of clinical decompensation. Receiver operating characteristic (ROC) curves were constructed to evaluate diagnostic capacity of HVPG. Results Median follow-up time of 51.1 months. Sixty-two (29%) of 213 patients developed decompensation: 46 (21.6%) ascites, 6 (3%) VH, 17 (8%) HE. Ten patients received a transplant and 12 died without clinical decompensation. Median HVPG at baseline was 11 mm Hg (range, 6-25 mm Hg). On multivariate analysis, 3 predictors of decompensation were identified: HVPG (hazard ratio [HR], 1.11; 95% confidence interval [CI], 1.05-1.17), model of end-stage liver disease (MELD) (HR, 1.15; 95% CI, 1.03-1.29), and albumin (HR, 0.37; 95% CI, 0.22-0.62). Diagnostic capacity of HVPG was greater than for MELD or Child-Pugh score. Conclusions HVPG, MELD, and albumin independently predict clinical decompensation in patients with compensated cirrhosis. Patients with an HVPG <10 mm Hg have a 90% probability of not developing clinical decompensation in a median follow-up of 4 years.
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Portal hypertension is the leading driver of hepatic decompensation in cirrhotic patients, also in NAFLD-associated ACLD.
“Portal hypertension is the leading driver of hepatic decompensation in cirrhotic patients [103], also in NAFLD‐associated ACLD (Paternostro et al. unpublished data).”
From Current treatment of non‐alcoholic fatty liver disease (2022) · cites this paper as [103]
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- Authors
- Ripoll, C., Groszmann, R., Garcia–Tsao, G., Grace, N., Burroughs, A., Planas, R., Escorsell, A., Garcia–Pagan, J. C., Makuch, R., Patch, D., Matloff, D. S., & Bosch, J.
- Affiliations
- Yale University (US)
- Brigham and Women's Hospital (US)
- The Royal Free Hospital (GB)
- Brigham and Women's Faulkner Hospital (US)
- Hospital Clínic de Barcelona (ES)
- Corresponding author
- Groszmann, Roberto
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2007-08
- Volume
- 133
- Issue
- 2
- Pages
- 481-488
- ISSN
- 0016-5085 (ISSN-L)
- OpenAlex
- W2101099470
- Cited by
- 1,183
- References
- 0
- Citations by year
- 2026: 51 · 2025: 83 · 2024: 99 · 2023: 81 · 2022: 82 · 2021: 83 · 2020: 91 · 2019: 78 · 2018: 65 · 2017: 56 · 2016: 52 · 2015: 81 · 2014: 54 · 2013: 40 · 2012: 55
- FWCI
- 22.37
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK46580, R01DK046580)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Hepatology › Liver physiology and pathology
- Keywords
- hepatic venous pressure gradient, compensated cirrhosis, clinical decompensation, portal hypertension, ascites, variceal bleeding, hepatic encephalopathy, MELD score, serum albumin, beta-blockers, liver transplantation, risk prediction
- MeSH terms
- Aged, Ascites, Esophageal and Gastric Varices, Female, Follow-Up Studies, Gastrointestinal Hemorrhage, Hepatic Encephalopathy, Humans, Hypertension, Portal, Liver Cirrhosis, Male, Middle Aged, Predictive Value of Tests, Prognosis, Prospective Studies, Risk Factors, ROC Curve, Sensitivity and Specificity, Severity of Illness Index, Time Factors, Proportional Hazards Models, Portal Pressure, Risk Assessment, Kaplan-Meier Estimate
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