title: Correlation of HVPG level with ctp score, MELD Score, ascites, size of varices, and etiology in cirrhotic patients.
abstract: OBJECTIVE
  This study intends to determine the correlation of a patient's hepatic venous pressure gradient (HVPG) measurement with six factors: Child-Turcotte-Pugh (CTP) score, model for end-stage liver disease (MELD) score, presence of ascites, size of varices, presence of variceal bleeding, and an etiology of cirrhosis. The study also aims to identify the predictors of higher HVPG measurements that can indirectly affect the prognosis of cirrhotic patients.
  
  
  METHODS
  Thirty patients diagnosed with cirrhosis were enrolled prospectively and each patient's HVPG level was measured by the transjugular catheterization of the right or middle hepatic vein. The wedged hepatic venous pressure (WHVP) and free hepatic venous pressure (FHVP) were measured using a 7F balloon catheter. The HVPG level was calculated as the difference between the WHVP and FHVP measurements.
  
  
  RESULTS
  The mean HVPG level was higher in alcoholic than in nonalcoholic cirrhosis (19.5 ± 7.3 vs 15.2 ± 4.5 mm Hg, P = 0.13). The mean HVPG was also higher in bleeders compared with nonbleeders (18.5 ± 5.3 vs 10.7 ± 3.1 mmHg, P = 0.001). Patients with varices had a higher mean HVPG level than those without varices (17.4 ± 5.8 vs 11.7 ± 3.9 mmHg, P = 0.04). The difference among the three categories of varices (small, large, and no varices) was statistically significant (P = 0.03). In addition, the mean HVPG level was higher in patients with ascites than in those without ascites (18.7 ± 4.7 vs 11 ± 5.3 mmHg, P = 0.002), and it was significantly higher in patients in CTP class C (21.8 ± 5.5 mmHg) as compared with those in CTP class B (16.9 ± 2.9 mmHg) and CTP class A (10.5 ± 4.1 mmHg; P ≤ 0.001).
  
  
  CONCLUSIONS
  HVPG levels were significantly higher in patients in CTP class C as compared with those in CTP classes A and B, thereby indicating that an HVPG measurement correlates with severity of liver disease. A high HVPG level signifies more severe liver disease and can predict the major complications of cirrhosis.
authors.forename: Subramaniam
authors.initials: S
authors.lastname: Ramanathan
authors.forename: Niranjan
authors.initials: N
authors.lastname: Khandelwal
authors.affiliation: Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, Haryana and Punjab, India.
authors.forename: Naveen
authors.initials: N
authors.lastname: Kalra
authors.forename: Anmol
authors.initials: A
authors.lastname: Bhatia
authors.forename: Radha K
authors.initials: RK
authors.lastname: Dhiman
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Duseja
authors.forename: Yogesh K
authors.initials: YK
authors.lastname: Chawla
mesh_terms: D000328:Adult; D000368:Aged; D001201:Ascites / Q000209:etiology / Q000503:physiopathology; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology / Q000473:pathology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult