Prognostic value of early measurements of portal pressure in acute variceal bleeding☆☆☆

Abstract 

Background & Aims: Variceal bleeding is the most important complication of portal hypertension. However, the relationship between the increase in portal pressure and the outcome of variceal bleeding has not been well defined. Methods: We measured the hepatic venous pressure gradient (HVPG) of 65 cirrhotic patients with acute variceal hemorrhage, early after admission (20.6 ± 15.6 hours). Results: Twenty-three patients had a poor evolution (failure to control bleeding or early variceal rebleeding), and 42 had an uneventful evolution. The only variable associated with outcome was the HVPG, which was higher in patients with a poor evolution (23.7 ± 6.1 vs. 19.2 ± 3.3 mm Hg; P < 0.0004). This was confirmed by multivariate analysis. HVPG was ≥20 mm Hg in 19 of 23 patients with poor evolution vs. 12 of 42 patients with uneventful evolution (P < 0.0001). An initial HVPG of ≥20 mm Hg was associated with a significantly longer intensive care unit stay (7 ± 5 vs. 4 ± 2 days; P < 0.02), longer hospital stay (19 ± 10 vs. 14 ± 6 days; P < 0.02), greater transfusion requirements (9.0 ± 7.7 vs. 4.7 ± 3.2 UU; P < 0.007), and a worse actuarial probability of survival (1-year mortality, 64% vs. 20%; P < 0.002). Conclusions: Early measurement of HVPG in cirrhotic patients during acute variceal bleeding provides useful prognostic information on the evolution of the bleeding episode and long-term survival.

GASTROENTEROLOGY 1999;117:626-631

Abbreviations:  FHVP , free hepatic venous pressure, HVPG , hepatic venous pressure gradient, ICU , intensive care unit, ROC , receiver operating characteristic, TIPS , transjugular intrahepatic portosystemic shunt, UU , units, WHVP , wedged hepatic venous pressure