肝静脉压力梯度可预测肝硬化急性食管静脉曲张出血患者的进一步失代偿。
Hepatic Venous Pressure Gradient Predicts Further Decompensation in Cirrhosis Patients with Acute Esophageal Variceal Bleeding.
作者信息
Vaishnav Manas, Biswas Sagnik, Anand Abhinav, Pathak Piyush, Swaroop Shekhar, Aggarwal Arnav, Arora Umang, Elhence Anshuman, Gamanagatti Shivanand, Goel Amit, Kumar Ramesh
机构信息
Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi 110029, India.
Department of Radiology, All India Institute of Medical Sciences, New Delhi 110029, India.
出版信息
Diagnostics (Basel). 2023 Jul 16;13(14):2385. doi: 10.3390/diagnostics13142385.
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 = 27 (18.6%) and new-onset/worsening ascites = 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.
背景
肝静脉压力梯度（HVPG）在预测肝硬化急性静脉曲张出血（AVB）患者进一步失代偿中的作用尚不清楚。我们旨在评估HVPG在预测肝硬化AVB患者进一步失代偿中的作用。方法：在这项前瞻性研究中，纳入了145例患有食管或胃AVB的肝硬化患者。在AVB当天测量HVPG。将AVB 42天后发生的失代偿事件视为进一步失代偿。
结果
研究队列的中位年龄为44岁；男性占88.3%。肝硬化的主要病因是酒精（46.2%）。总体而言，在AVB后中位随访296天期间，40例（27.6%）患者发生了进一步失代偿。胃肠道出血=27例（18.6%）和新发/加重腹水=20例（13.8%）是最常见的失代偿事件。根据多变量模型，HVPG是食管AVB患者任何进一步失代偿的独立预测因素，但不是胃静脉曲张出血患者的独立预测因素。HVPG≥16 mmHg的临界值可预测食管AVB的进一步失代偿。然而，HVPG不是死亡率的独立预测因素。
结论
在食管静脉曲张急性曲张出血发作期间测量的HVPG可预测肝硬化患者的进一步失代偿事件。
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