Hepatic venous pressure gradient predicts clinical decompensation in patients with compensated cirrhosis.
OBJECTIVE
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.
Veterans Affairs CT Healthcare System, Yale University School of Medicine, West Haven, Connecticut 06516, USA.
Cristina
C
Ripoll
Roberto
R
Groszmann
Guadalupe
G
Garcia-Tsao
Norman
N
Grace
Andrew
A
Burroughs
Ramon
R
Planas
Angels
A
Escorsell
Juan Carlos
JC
Garcia-Pagan
Robert
R
Makuch
David
D
Patch
Daniel S
DS
Matloff
Jaime
J
Bosch
D000368:Aged; D001201:Ascites / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D006501:Hepatic Encephalopathy / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013997:Time Factors