title: Prognostic value of hepatic venous pressure gradient in patients with compensated chronic hepatitis C-related cirrhosis.
abstract: OBJECTIVE
  Hepatic venous pressure gradient (HVPG) is the main predictor of clinical decompensation in cirrhotic patients with compensated disease of any etiology without varices. However, the predictive factors of decompensation are not so well known in patients with hepatitis C-related compensated cirrhosis, in whom etiology-based therapy is difficult. The aim of this study was to identify predictors of decompensation in patients with compensated chronic hepatitis C (CHC)-related cirrhosis with and without esophageal varices (Baveno stages 1 and 2).
  
  
  METHODS
  The study population was a cohort of 145 of such consecutive patients who received hepatic hemodynamic study. All patients were similarly followed every 6 months. Through multivariate Cox regression and bootstrap analyses, a prognostic index (PI) was developed and tested in an external cohort (n = 38).
  
  
  RESULTS
  Forty-two patients (29%) suffered a first decompensation episode after a median follow-up of 27 months (2-110). Cox regression analysis identified HVPG (hazard ratio (HR) 1.11; 95% confidence interval (CI): 1.05-1.17) and albumin (HR 0.42; 95% CI: 0.22-0.82) as independent predictors of decompensation. Bootstrapping confirmed that HVPG (95% CI: 1.05-1.18) and albumin (95% CI: 0.12-0.74) were the most robust predictive variables. Using a cut-off level of 2.5, the PI [4 + (0.11 × HVPG - 0.8 × albumin)] was able to distinguish two populations of patients with very different risks of decompensation in both the exploratory and validation cohorts. A time-dependent ROC curve identified HVPG as the best predictive variable.
  
  
  CONCLUSIONS
  HVPG and albumin are independent predictors of clinical decompensation in patients with compensated CHC-related cirrhosis irrespective of the existence of varices.
authors.affiliation: Hepatic Hemodynamic Laboratory, Liver Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Diego
authors.initials: D
authors.lastname: Rincón
authors.forename: Oreste
authors.initials: O
authors.lastname: Lo Iacono
authors.forename: Marta
authors.initials: M
authors.lastname: Tejedor
authors.forename: Ana
authors.initials: A
authors.lastname: Hernando
authors.forename: Cristina
authors.initials: C
authors.lastname: Ripoll
authors.forename: María-Vega
authors.initials: MV
authors.lastname: Catalina
authors.forename: Magdalena
authors.initials: M
authors.lastname: Salcedo
authors.forename: Ana
authors.initials: A
authors.lastname: Matilla
authors.forename: María
authors.initials: M
authors.lastname: Senosiain
authors.forename: Gerardo
authors.initials: G
authors.lastname: Clemente
authors.forename: Luis-Miguel
authors.initials: LM
authors.lastname: Molinero
authors.forename: Agustín
authors.initials: A
authors.lastname: Albillos
authors.forename: Rafael
authors.initials: R
authors.lastname: Bañares
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006503:Hepatic Veins; D019698:Hepatitis C, Chronic / Q000097:blood / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D006975:Hypertension, Portal / Q000097:blood / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology*; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012709:Serum Albumin / Q000378:metabolism; D012720:Severity of Illness Index; D014690:Venous Pressure
chemical_list: D015415:Biomarkers; D012709:Serum Albumin