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Title: The prognostic role of hepatic venous pressure gradient in cirrhotic patients undergoing elective extrahepatic surgery
Author: Reverter, Enric
Cirera, Isabel
Albillos, Agustín
Debernardi-Venon, Wilma
Abraldes, Juan G.
Llop, Elba
Flores, Alexandra
Martínez Palli, Graciela
Blasi Ibáñez, Annabel
Martínez González, Javier
Turon, Fanny
García-Valdecasas Salgado, Juan Carlos
Berzigotti, Annalisa
Lacy Fortuny, Antonio Ma. de
Fuster Obregón, Josep
Hernández Gea, Virginia
Bosch i Genover, Jaume
García Pagán, Juan Carlos
Keywords: Pressió venosa
Cirrosi hepàtica
Venous pressure
Hepatic cirrhosis
Issue Date: 19-Jul-2019
Publisher: Elsevier
Abstract: Background & Aims: Surgery in cirrhosis is associated with a high morbidity and mortality. Retrospectively reported prognostic factors include emergency procedures, liver function (MELD/Child-Pugh scores) and portal hypertension (assessed by indirect markers). This study assessed the prognostic role of hepatic venous pressure gradient (HVPG) and other variables in elective extrahepatic surgery in patients with cirrhosis. Methods: A total of 140 patients with cirrhosis (Child-Pugh A/B/C: 59/37/4%), who were due to have elective extrahepatic surgery (121 abdominal; 9 cardiovascular/thoracic; 10 orthopedic and others), were prospectively included in 4 centers (2002–2011). Hepatic and systemic hemodynamics (HVPG, indocyanine green clearance, pulmonary artery catheterization) were assessed prior to surgery, and clinical and laboratory data were collected. Patients were followed-up for 1 year and mortality, transplantation, morbidity and post-surgical decompensation were studied. Results: Ninety-day and 1-year mortality rates were 8% and 17%, respectively. Variables independently associated with 1-year mortality were ASA class (American Society of Anesthesiologists), high-risk surgery (defined as open abdominal and cardiovascular/thoracic) and HVPG. These variables closely predicted 90-, 180- and 365-day mortality (C-statistic >0.8). HVPG values >16 mmHg were independently associated with mortality and values ≥20 mmHg identified a subgroup at very high risk of death (44%). Twenty-four patients presented persistent or de novo decompensation at 3 months. Low body mass index, Child-Pugh class and high-risk surgery were associated with death or decompensation. No patient with HVPG <10 mmHg or indocyanine green clearance >0.63 developed decompensation. Conclusions: ASA class, HVPG and high-risk surgery were prognostic factors of 1-year mortality in cirrhotic patients undergoing elective extrahepatic surgery. HVPG values >16 mmHg, especially ≥20 mmHg, were associated with a high risk of post-surgical mortality. Lay summary: The hepatic venous pressure gradient is associated with outcomes in patients with cirrhosis undergoing elective extrahepatic surgery. It enables a better stratification of risk in these patients and provides the foundations for potential interventions to improve post-surgical outcomes.
Note: Versió postprint del document publicat a:
It is part of: Journal of Hepatology, 2019, vol. 71, num. 5, p. 942-950
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ISSN: Abraldes JG;Albillos A;Berzigotti A;Blasi A;Bosch J;Carles García-Pagán J;Carlos García-Valdecasas J;Cirera I;De Lacy AM;Debernardi-Venon W;Flores A;Fuster J;Hernández-Gea V;Llop E;Martinez J;Martinez-Palli G;Reverter E;Turon F. The prognostic role of hepatic venous pressure gradient in cirrhotic patients undergoing elective extrahepatic surgery. JOURNAL OF HEPATOLOGY, 2019, 71, 5, 942-950
Appears in Collections:Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)

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