title: Timing Affects Measurement of Portal Pressure Gradient After Placement of Transjugular Intrahepatic Portosystemic Shunts in Patients With Portal Hypertension.
abstract: A reduction in portal pressure gradient (PPG) to <12 mm Hg after placement of a transjugular intrahepatic portosystemic shunt (TIPS) correlates with the absence of further bleeding or ascites at follow-up examinations of patients with cirrhosis. The PPG is usually measured immediately after placement of the TIPS, when different circumstances can affect PPG values, which could affect determination of risk for decompensation. We investigated variations in PPG measurements collected at different time points after TIPS, aiming to identify a time point after which PPG values were best maintained.
  
  
  
  We performed a retrospective study of 155 consecutive patients with severe complications of portal hypertension who received placement of TIPS from January 2008 through October 2015; patients were followed until March 2016. We compared PPG values measured at different time points and under different conditions: immediately after placement of TIPS (immediate PPG); at least 24 hours after placement to TIPS into hemodynamically stable patients, without sedation (early PPG); and again 1 month after TIPS placement (late PPG).
  
  
  
  The immediate PPG differed significantly from the early PPG, regardless of whether the TIPS was placed using general anesthesia (8.5 ± 3.5 mm Hg vs 10 ± 3.5 mm Hg; P = .015) or deep sedation (12 ± 4 mm Hg vs 10.5 ± 4 mm Hg; P <.001). In considering the 12 mm Hg threshold, concordance between immediate PPG and early PPG values was poor. However, there was no significant difference between mean early PPG and late PPG values (8.5 ± 2.5 mm Hg vs 8 ± 3 mm Hg), or between proportions of patients with early PPG vs late PPG values <12 mm Hg threshold. Maintenance of a PPG value <12 mm Hg during the follow-up period was associated with a lower risk of recurrent or de novo variceal bleeding or ascites (hazard ratio, 0.11; 95% confidence interval, 0.04 0.27; P < .001).
  
  
  
  In a retrospective study of patients with PPG values measured at different time points after TIPS placement, we found measurements of PPG in awake, hemodynamically stable patients at least 24 hours after TIPS to be the best maintained values. Our findings support the concept that PPG value <12 mm Hg after TIPS placement is associated with reduced risk of bleeding and ascites.
authors.affiliation: Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut d'investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Spain.
authors.forename: Gilberto
authors.initials: G
authors.lastname: Silva-Junior
authors.affiliation: Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut d'investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Spain.
authors.forename: Fanny
authors.initials: F
authors.lastname: Turon
authors.affiliation: Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut d'investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Baiges
authors.affiliation: Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut d'investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Spain.
authors.forename: Eira
authors.initials: E
authors.lastname: Cerda
authors.affiliation: Centre de Diagnostic per l'Imatge, Hospital Clínic, Barcelona, Spain.
authors.forename: Ángeles
authors.initials: Á
authors.lastname: García-Criado
authors.affiliation: Anesthesiology Department, Hospital Clínic, Institut d'investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
authors.forename: Annabel
authors.initials: A
authors.lastname: Blasi
authors.affiliation: Biostatistics and Data Management Core Facility, Institut d'investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic Barcelona, Barcelona, Spain; Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Ferran
authors.initials: F
authors.lastname: Torres
authors.affiliation: Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut d'investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain.
authors.forename: Virginia
authors.initials: V
authors.lastname: Hernandez-Gea
authors.affiliation: Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut d'investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain; Swiss Liver Center, Inselspital, Berne University, Switzerland.
authors.forename: Jaume
authors.initials: J
authors.lastname: Bosch
authors.affiliation: Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut d'investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain. Electronic address: jcgarcia@clinic.cat.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Garcia-Pagan
mesh_terms: D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D001795:Blood Pressure Determination; D054810:Deep Sedation; D004932:Esophageal and Gastric Varices / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors
keywords: Liver Cirrhosis; Portal Hypertension; Portal Pressure Measurement