Prognostic value of hepatic venous pressure gradient measurements in alcoholic cirrhosis: a 10-year prospective study.
OBJECTIVE
Different parameters are considered predictors of bleeding and death in alcoholic cirrhosis. The aim of this study was to establish the prognostic value of a prospective and sequential evaluation of portal pressure, variceal size, and Pugh's score in portal-hypertensive patients with alcoholic cirrhosis but no previous bleeding.


METHODS
Thirty patients were evaluated for 42 +/- 5 months (median, 39 months). After baseline studies, 30 patients underwent an additional evaluation (follow-up 1; median, 10 months), 20 patients a second evaluation (follow-up 2; median, 25 months), and 13 patients a third evaluation (follow-up 3; median, 45 months). No prophylactic treatment for bleeding was given. End points were bleeding and/or death.


RESULTS
Seventeen patients died, and 10 patients bled. At follow-up 1, portal pressure decreased both in survivors and nonbleeders (from 18.7 +/- 1.0 to 15.2 +/- 1.3 mm Hg [P < 0.01] and from 18.9 +/- 0.8 to 16.5 +/- 1.0 mm Hg [P < 0.05], respectively). On multivariate analysis (Cox model), portal pressure at follow-up 1 had the best prognostic and independent value for both bleeding and survival. Subsequent studies showed similar trends.


CONCLUSIONS
Measurements of portal pressure provide unique prognostic information for predicting portal hypertensive-related bleeding and mortality in patients with alcoholic cirrhosis.
Vorobioff
J
J
Liver Unit, Policlínico Ferroviario, Rosario, Argentina.
Groszmann
R J
RJ
Picabea
E
E
Gamen
M
M
Villavicencio
R
R
Bordato
J
J
Morel
I
I
Audano
M
M
Tanno
H
H
Lerner
E
E
Passamonti
M
M
D000328:Adult; D000428:Alcohol Drinking; D002404:Catheterization; D004724:Endoscopy; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000473:pathology; D005260:Female; D006439:Hemodynamics; D006470:Hemorrhage / Q000209:etiology; D006503:Hepatic Veins / Q000503:physiopathology*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D014690:Venous Pressure