title: Prognostic value of a single HVPG measurement and Doppler-ultrasound evaluation in patients with cirrhosis and portal hypertension.
abstract: BACKGROUND
  In patients with cirrhosis the onset of clinically significant portal hypertension (CSPH; i.e., hepatic venous pressure gradient (HVPG) ≥ 10 mmHg) is associated with an increased risk of complications. However, most cirrhotic patients already have CSPH at presentation, and limited information is available on further risk stratification in this population. This study assessed the prognostic value of a single HVPG measurement and Doppler-ultrasound (US) evaluation in patients with cirrhosis and CSPH.
  
  
  METHODS
  Eighty-six consecutive patients with cirrhosis (73% compensated) and untreated CSPH (mean HVPG 17.8 ± 5.1 mmHg) were included. All were studied by paired HVPG and US, and followed up for a minimum of 12 months (mean 28 ± 20 months).
  
  
  RESULTS
  Sixteen (25.3%) patients developed a first decompensation, and 11.6% died on follow-up. HVPG (per 1 mmHg increase OR 1.22, 95% CI 1.05-1.40, p = 0.007) and bilirubin (per 1 mg/ml increase OR 2.42, 95% CI 0.93-6.26, p = 0.06) independently predicted first decompensation, and Model for End-Stage Liver Disease (MELD) score (per 1 point increase OR 1.24, 95% CI 1.03-1.51, p = 0.03) and HVPG (per 1 mmHg increase OR 1.08, 95% CI 1.01-1.26, p = 0.05) independently predicted mortality. The best HVPG cutoff predicting these events was 16 mmHg. Ultrasonographic parameters lacked independent predictive value. The ultrasonographic detection of abdominal collaterals had a high positive likelihood ratio (7.03, 95% CI 2.23-22.16) for the prediction of HVPG ≥ 16 mmHg, implying an increase of the probability of belonging to this higher-risk population from 58 to 91%.
  
  
  CONCLUSIONS
  HVPG holds an independent predictive value for first decompensation and death in patients with CSPH. The ultrasonographic detection of collaterals allows the non-invasive identification of patients with HVPG ≥ 16 mmHg, who are at higher risk.
authors.affiliation: Department of Internal Medicine, Ageing and Nephrology, University of Bologna, Policlinico S. Orsola-Malpighi, Via Albertoni 15, 40138 Bologna, Italy. aberzigo@clinic.ub.es
authors.forename: Annalisa
authors.initials: A
authors.lastname: Berzigotti
authors.forename: Valentina
authors.initials: V
authors.lastname: Rossi
authors.forename: Carolina
authors.initials: C
authors.lastname: Tiani
authors.forename: Lucia
authors.initials: L
authors.lastname: Pierpaoli
authors.forename: Paola
authors.initials: P
authors.lastname: Zappoli
authors.forename: Anna
authors.initials: A
authors.lastname: Riili
authors.forename: Carla
authors.initials: C
authors.lastname: Serra
authors.forename: Pietro
authors.initials: P
authors.lastname: Andreone
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Morelli
authors.forename: Rita
authors.initials: R
authors.lastname: Golfieri
authors.forename: Cristina
authors.initials: C
authors.lastname: Rossi
authors.forename: Donatella
authors.initials: D
authors.lastname: Magalotti
authors.forename: Marco
authors.initials: M
authors.lastname: Zoli
mesh_terms: D000368:Aged; D001795:Blood Pressure Determination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology*; D008103:Liver Cirrhosis / Q000150:complications* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D018616:Ultrasonography, Doppler, Duplex