Usefulness of portal vein pressure for predicting the effects of tolvaptan in cirrhotic patients.
OBJECTIVE
To elucidate influencing factors of treatment response, then tolvaptan has been approved in Japan for liquid retention.


METHODS
We herein conducted this study to clarify the influencing factors in 40 patients with decompensated liver cirrhosis complicated by liquid retention. Tolvaptan was administered at a dosage of 7.5 mg once a day for patients with conventional diuretic-resistant hepatic edema for 7 d. At the initiation of tolvaptan, the estimated hepatic venous pressure gradient (HVPG) value which was estimated portal vein pressure was measured using hepatic venous catheterization. We analyzed the effects of tolvaptan and influencing factors associated with treatment response.


RESULTS
Subjects comprised patients with a median age of 65 (range, 40-82) years. According to the Child-Pugh classification, class A was 3 patients, class B was 19, and class C was 18. Changes from the baseline in body weight were -1.0 kg (P = 2.04 × 10(-6)) and -1.3 kg (P = 1.83 × 10(-5)), respectively. The median HVPG value was 240 (range, 105-580) mmH2O. HVPG was only significant influencing factor of the weight loss effect. When patients with body weight loss of 2 kg or greater from the baseline was defined as responders, receiver operating characteristic curve analysis showed that the optimal HVPG cutoff value was 190 mmH2O in predicting treatment response. The response rate was 87.5% (7/8) in patients with HVPG of 190 mmH2O or less, whereas it was only 12.5% (2/16) in those with HVPG of greater than 190 mmH2O (P = 7.46 × 10(-4)). We compared each characteristics factors between responders and non-responders. As a result, HVPG (P = 0.045) and serum hyaluronic acid (P = 0.017) were detected as useful factors.


CONCLUSIONS
The present study suggests that tolvaptan in the treatment of liquid retention could be more effective for patients with lower portal vein pressure.
Ai Nakagawa, Masanori Atsukawa, Chisa Kondo, Tomomi Okubo, Taeang Arai, Norio Itokawa, Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School Chiba Hokusoh Hospital, Chiba 270-1694, Japan.
Ai
A
Nakagawa
Ai Nakagawa, Masanori Atsukawa, Chisa Kondo, Tomomi Okubo, Taeang Arai, Norio Itokawa, Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School Chiba Hokusoh Hospital, Chiba 270-1694, Japan.
Masanori
M
Atsukawa
Ai Nakagawa, Masanori Atsukawa, Chisa Kondo, Tomomi Okubo, Taeang Arai, Norio Itokawa, Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School Chiba Hokusoh Hospital, Chiba 270-1694, Japan.
Akihito
A
Tsubota
Ai Nakagawa, Masanori Atsukawa, Chisa Kondo, Tomomi Okubo, Taeang Arai, Norio Itokawa, Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School Chiba Hokusoh Hospital, Chiba 270-1694, Japan.
Chisa
C
Kondo
Ai Nakagawa, Masanori Atsukawa, Chisa Kondo, Tomomi Okubo, Taeang Arai, Norio Itokawa, Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School Chiba Hokusoh Hospital, Chiba 270-1694, Japan.
Tomomi
T
Okubo
Ai Nakagawa, Masanori Atsukawa, Chisa Kondo, Tomomi Okubo, Taeang Arai, Norio Itokawa, Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School Chiba Hokusoh Hospital, Chiba 270-1694, Japan.
Taeang
T
Arai
Ai Nakagawa, Masanori Atsukawa, Chisa Kondo, Tomomi Okubo, Taeang Arai, Norio Itokawa, Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School Chiba Hokusoh Hospital, Chiba 270-1694, Japan.
Norio
N
Itokawa
Ai Nakagawa, Masanori Atsukawa, Chisa Kondo, Tomomi Okubo, Taeang Arai, Norio Itokawa, Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School Chiba Hokusoh Hospital, Chiba 270-1694, Japan.
Yoshiyuki
Y
Narahara
Ai Nakagawa, Masanori Atsukawa, Chisa Kondo, Tomomi Okubo, Taeang Arai, Norio Itokawa, Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School Chiba Hokusoh Hospital, Chiba 270-1694, Japan.
Katsuhiko
K
Iwakiri
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D065092:Antidiuretic Hormone Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D001552:Benzazepines / Q000009:adverse effects / Q000627:therapeutic use*; D004487:Edema / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D017082:Portal Pressure; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013997:Time Factors; D000077602:Tolvaptan; D016896:Treatment Outcome; D014882:Water-Electrolyte Balance / Q000187:drug effects*; D014883:Water-Electrolyte Imbalance / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology
D065092:Antidiuretic Hormone Receptor Antagonists; D001552:Benzazepines; D000077602:Tolvaptan
Decompensated chirrosis; Hepatic venous pressure gradient; Portal vein pressure; Tolvaptan; V2 receptor antagonist