Hemodynamic response to pharmacological treatment of portal hypertension and long-term prognosis of cirrhosis.
In cirrhotic patients under pharmacologic treatment for portal hypertension, a reduction in hepatic venous pressure gradient (HVPG) of >or=20% of baseline or to <or=12 mm Hg markedly reduces the risk of variceal rebleeding. This study was aimed at evaluating whether these hemodynamic targets also prevent other complications of portal hypertension and improve long-term survival. One hundred five cirrhotic patients included in prospective trials for the prevention of variceal rebleeding were studied. Seventy-three of the patients had 2 separate HVPG measurements, at baseline and under pharmacologic therapy with propranolol +/- isosorbide mononitrate. Patients were followed for up to 8 years. Survival and risk of developing portal hypertension-related complications were compared between responders and nonresponders. Twenty-eight patients showed a reduction of HVPG >or=20% of baseline or to <or=12 mm Hg (responders), and 45 patients were nonresponders. Nonresponders had a significantly greater risk of developing variceal rebleeding (P =.013), ascites (P =.025), spontaneous bacterial peritonitis (P =.003), hepatorenal syndrome (P =.026), and hepatic encephalopathy (P =.024) than responders. Eight-year cumulative probability of survival was significantly lower in nonresponders than in responders (52% vs. 95%, respectively, P =.003). At multivariate analysis, being a nonresponder was independently associated with the risk of developing rebleeding, ascites, spontaneous bacterial peritonitis, and lower survival. In conclusion, in cirrhotic patients receiving pharmacologic treatment for prevention of variceal rebleeding, a decrease in HVPG >or=20% or to <or=12 mm Hg is associated with a marked reduction in the long-term risk of developing complications of portal hypertension and with improved survival.
Abraldes
Juan G
JG
Hepatic Hemodynamic Laboratory, Liver Unit, Institut de Malalties Digestives, Hospital Clínic, Institut de Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.
Tarantino
Ilaria
I
Turnes
Juan
J
Garcia-Pagan
Juan Carlos
JC
Rodés
Juan
J
Bosch
Jaime
J
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001201:Ascites / Q000209:etiology; D001424:Bacterial Infections / Q000209:etiology; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006470:Hemorrhage / Q000209:etiology / Q000503:physiopathology; D006501:Hepatic Encephalopathy / Q000209:etiology; D006530:Hepatorenal Syndrome / Q000209:etiology; D006801:Humans; D006975:Hypertension, Portal / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D007548:Isosorbide Dinitrate / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000382:microbiology; D011336:Probability; D011379:Prognosis; D011433:Propranolol / Q000627:therapeutic use*; D012008:Recurrence; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D014648:Varicose Veins / Q000150:complications; D014665:Vasodilator Agents / Q000627:therapeutic use*
D000959:Antihypertensive Agents; D014665:Vasodilator Agents; D011433:Propranolol; D007548:Isosorbide Dinitrate; C030397:isosorbide-5-mononitrate