Association Between Severe Portal Hypertension and Risk of Liver Decompensation in Patients With Hepatitis C, Regardless of Response to Antiviral Therapy.
OBJECTIVE
Hepatic venous pressure gradient (HVPG) is associated with a risk of liver events in patients with chronic hepatitis C. Antiviral therapies that lead to a sustained virologic response (SVR) reduce portal pressure and prevent liver disease progression. However, it is not clear to what extent the progression of hepatitis C is modified once patients develop cirrhosis with severe portal hypertension (CSPH) (HVPG ≥ 10 mm Hg). We assessed the effects of HVPG and SVR on the risk of liver decompensation, hepatocellular carcinoma, and/or death in patients with hepatitis C-related cirrhosis.


METHODS
We collected data from 100 patients with hepatitis C and compensated cirrhosis who underwent HVPG measurement 3 months or less before (baseline) and 24 weeks after therapy with pegylated interferon alfa-2a and ribavirin at 4 hospitals in Spain, from 2001 through 2009. SVR was defined as undetectable serum HCV RNA level 24 weeks after treatment ended. Clinical data were collected until death, liver transplantation, or December 2012 (median, 5 y; interquartile range, 1.4-7 y).


RESULTS
Seventy-four patients had CSPH at baseline and 35% of patients achieved an SVR. During the follow-up period, 19 patients developed liver decompensation (ascites, variceal bleeding, or encephalopathy). The actuarial probability values for liver decompensation at 1, 5, and 7 years were 3%, 19% and 22%, respectively. The baseline level of HVPG, but not SVR, was associated independently with the risk of liver decompensation.


CONCLUSIONS
Patients with CSPH, regardless of an SVR to therapy for hepatitis C, remain at risk for liver decompensation within the first 5 years after treatment; they should be monitored closely.
Liver Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August-Pi-Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivass, Spain.
Sabela
S
Lens
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivass, Spain; Liver Unit, Hospital Gregorio Marañón, Madrid, Spain.
Diego
D
Rincón
Liver Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August-Pi-Sunyer, Barcelona, Spain.
Montserrat
M
García-Retortillo
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivass, Spain; Liver Unit, Hospital Ramón y Cajal, Madrid, Spain.
Agustín
A
Albillos
Liver Unit, Hospital Puerta del Hierro, IDIPHIM, Madrid, Spain.
Jose Luis
JL
Calleja
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivass, Spain; Liver Unit, Hospital Gregorio Marañón, Madrid, Spain.
Rafael
R
Bañares
Liver Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August-Pi-Sunyer, Barcelona, Spain; Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Barcelona, Spain.
Juan González
JG
Abraldes
Liver Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August-Pi-Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivass, Spain; Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Barcelona, Spain.
Jaume
J
Bosch
Liver Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August-Pi-Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivass, Spain.
Jose Maria
JM
Sanchez-Tapias
Liver Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August-Pi-Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivass, Spain.
Xavier
X
Forns
Liver Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August-Pi-Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivass, Spain; Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Barcelona, Spain. Electronic address: jcgarcia@clinic.ub.es.
Juan Carlos
JC
García-Pagán
D000998:Antiviral Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000401:mortality; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000401:mortality / Q000473:pathology*; D016898:Interferon-alpha / Q000627:therapeutic use; D017093:Liver Failure / Q000150:complications / Q000453:epidemiology*; D008113:Liver Neoplasms / Q000453:epidemiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000627:therapeutic use; D012254:Ribavirin / Q000627:therapeutic use; D018570:Risk Assessment; D013030:Spain; D016019:Survival Analysis; D016896:Treatment Outcome; D019562:Viral Load
D000998:Antiviral Agents; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a
Cirrhosis; HCV; HVPG; Treatment