title: Prognostic markers in patients with cirrhosis and portal hypertension who have not bled.
abstract: Prognostic markers of compensated cirrhosis should mainly investigate factors involved with progression to decompensation because death in cirrhosis is related with decompensation. Portal hypertension plays a crucial role in the pathophysiology of most complications of cirrhosis. Accordingly, HVPG monitoring has strong prognostic value. An HVPG ≥ 10 mmHg determines a significantly higher risk of developing decompensation. Esophageal varices also can develop when the HVPG is ≥ 10 mmHg, although an HVPG ≥ 12 mmHg is required for variceal bleeding to occur. Monitoring the changes induced by the treatment of portal hypertension on HVPG, provides strong prognostic information. In compensated cirrhosis hemodynamic response is appropriate when the HVPG decreased to < 10 mmHg or by > 10% from baseline, because the incidence of complications such as bleeding or ascites significantly decrease when these targets are achieved. Whether serum markers, such as the FibroTest, they, may be valuable to predict decompensation should be established. Transient Elastography is a promising technique that has shown an excellent accuracy to detect severe portal hypertension. However, whether it can adequately determine clinically significant portal hypertension, and risk of developing varices and decompensation, should be established. Magnetic Resonance Elastography is also promising.
authors: Gastrointestinal Bleeding Unit, Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Autonomous University, Barcelona, Spain.
authors: Maria
authors: M
authors: Poca
authors: Angela
authors: A
authors: Puente
authors: Isabel
authors: I
authors: Graupera
authors: Càndid
authors: C
authors: Villanueva
mesh_terms: D001201:Ascites / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D015415:Biomarkers / Q000032:analysis; D054459:Elasticity Imaging Techniques; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D006470:Hemorrhage / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D008099:Liver / Q000473:pathology* / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D017082:Portal Pressure; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers