title: Relationship between indocyanine green retention test, decompensation and survival in patients with Child-Pugh A cirrhosis and portal hypertension.
abstract: Indocyanine green retention test (ICG-r15) is a non-invasive marker of functional hepatic reserve. Among patients with compensated cirrhosis, ICG-r15 correlates to the degree of portal hypertension (PH); however, its prognostic relationship with the occurrence of decompensation events still requires clarification.
  
  
  
  ICG-r15 was prospectively measured in 154 patients with compensated cirrhosis. Patients with hepatocellular carcinoma (HCC), Child-Pugh B-C, MELD>15, bilirubin > 2 mg/dl, INR > 1.5 or portal vein thrombosis were excluded. All patients underwent laboratory tests, upper endoscopy and hepatic venous pressure gradient (HVPG). Decompensation, development of HCC, liver transplant and death were recorded and analysed through competing-risk analysis.
  
  
  
  The study group was composed of 134 patients who were followed for a median of 39 months. During follow-up, 46 patients (34.3%) developed liver decompensation. Hepatocellular carcinoma occurred in 18 patients and two patients died from non-liver-related causes. The 1-, 2- and 3-year cumulative incidences of decompensation were 9.7%, 28.4% and 33.4% respectively. Patients with ICG-r15 < 10% did not experience any decompensation events during follow-up, while the 3-year cumulative incidence of decompensation of patients with ICG-r15 between 10% and 22.9% was 29.2% and that of patients with ICG-r15 ≥ 23% was 70.0% (P < 0.001). ICG-r15 gave the lowest pseudo-log-likelihood value, in comparison to oesophageal varices present, MELD, low platelet count and HVPG.
  
  
  
  ICG-r15 appears to be strictly related to liver decompensation, longitudinally confirming the preliminary findings of its correlation with PH among patients with compensated cirrhosis, and can be used for patient prognostication.
authors.affiliation: Department of Medical and Surgical Science - DIMEC, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Lisotti
authors.affiliation: Department of Medical and Surgical Science - DIMEC, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Azzaroli
authors.affiliation: Department of Medical and Surgical Science - DIMEC, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Alessandro
authors.identifier: 0000-0001-5269-1964
authors.initials: A
authors.lastname: Cucchetti
authors.affiliation: Department of Medical and Surgical Science - DIMEC, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Buonfiglioli
authors.affiliation: Department of Medical and Surgical Science - DIMEC, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Cecinato
authors.affiliation: Department of Medical and Surgical Science - DIMEC, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Calvanese
authors.affiliation: Department of Medical and Surgical Science - DIMEC, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Simoni
authors.affiliation: Department of Medical and Surgical Science - DIMEC, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Rosario
authors.initials: R
authors.lastname: Arena
authors.affiliation: Department of Medical and Surgical Science - DIMEC, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Montagnani
authors.affiliation: Radiology Unit, Department of Digestive Diseases and Internal Medicine, S.Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Golfieri
authors.affiliation: Department of Medical and Surgical Science - DIMEC, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Colecchia
authors.affiliation: Department of Medical and Surgical Science - DIMEC, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Festi
authors.affiliation: Department of Medical and Surgical Science - DIMEC, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mazzella
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D006528:Carcinoma, Hepatocellular / Q000150:complications; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000150:complications; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000175:diagnosis*; D015994:Incidence; D007208:Indocyanine Green / Q000378:metabolism*; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications* / Q000503:physiopathology; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000150:complications; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D018570:Risk Assessment
chemical_list: D015415:Biomarkers; D007208:Indocyanine Green
keywords: ascites; bleeding; hepatic venous pressure gradient; non-invasive assessment; upper endoscopy