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http://hdl.handle.net/2445/160312
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DC Field | Value | Language |
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dc.contributor.author | Mandorfer, Mattias | - |
dc.contributor.author | Kozbial, Karin | - |
dc.contributor.author | Schwabl, Philipp | - |
dc.contributor.author | Chromy, David | - |
dc.contributor.author | Semmler, Georg | - |
dc.contributor.author | Stättermayer, Albert F. | - |
dc.contributor.author | Pinter, Matthias | - |
dc.contributor.author | Hernández Gea, Virginia | - |
dc.contributor.author | Fritzer-Szekere, Monika | - |
dc.contributor.author | Steindl-Munda, Petra | - |
dc.contributor.author | Trauner, Michael | - |
dc.contributor.author | Peck-Radosavljevic, Markus | - |
dc.contributor.author | García Pagán, Juan Carlos | - |
dc.contributor.author | Ferenci, Peter | - |
dc.contributor.author | Reiberger, Thomas | - |
dc.date.accessioned | 2020-05-14T17:26:35Z | - |
dc.date.available | 2020-05-14T17:26:35Z | - |
dc.date.issued | 2020-03-01 | - |
dc.identifier.issn | 1527-3350 | - |
dc.identifier.uri | http://hdl.handle.net/2445/160312 | - |
dc.description.abstract | BaCKgRoUND aND aIMS: Sustained virologic response (SVR) to interferon (IFN)-free therapies ameliorates portal hypertension (PH); however, it remains unclear whether a decrease in hepatic venous pressure gradient (HVPG) after cure of hepatitis C translates into a clinical benefit. We as- sessed the impact of pretreatment HVPG, changes in HVPG, and posttreatment HVPG on the development of hepatic decompensation in patients with PH who achieved SVR to IFN-free therapy. Moreover, we evaluated transient elastogra- phy (TE) and von Willebrand factor to platelet count ratio (VITRO) as noninvasive methods for monitoring the evolu- tion of PH. appRoaCH aND ReSUltS: The study comprised 90 patients with HVPG ≥ 6 mm Hg who underwent paired HVPG, TE, and VITRO assessments before (baseline [BL]) and after (follow-up [FU]) IFN-free therapy. FU HVPG but not BL HVPG predicted hepatic decompensation (per mm Hg, hazard ratio, 1.18; 95% confidence interval, 1.08- 1.28; P < 0.001). Patients with BL HVPG ≤ 9 mm Hg or patients who resolved clinically significant PH (CSPH) were protected from hepatic decompensation. In patients with CSPH, an HVPG decrease ≥ 10% was similarly protective (36 months, 2.5% vs. 40.5%; P < 0.001) but was observed in a substantially higher proportion of patients (60% vs. 24%; P < 0.001). Importantly, the performance of noninva- sive methods such as TE/VITRO for diagnosing an HVPG reduction ≥ 10% was inadequate for clinical use (area under the receiver operating characteristic curve [AUROC], < 0.8), emphasizing the need for HVPG measurements. However, TE/VITRO were able to rule in or rule out FU CSPH (AUROC, 0.86-0.92) in most patients, especially if assessed in a sequential manner. CoNClUSIoNS: Reassessment of HVPG after SVR im- proved prognostication in patients with pretreatment CSPH. An “immediate” HVPG decrease ≥ 10% was observed in the majority of these patients and was associated with a clinical benefit, as it prevented hepatic decompensation. These results support the use of HVPG as a surrogate endpoint for inter- ventions that lower portal pressure by decreasing intrahepatic resistance. | - |
dc.format.extent | 14 p. | - |
dc.format.mimetype | application/pdf | - |
dc.language.iso | eng | - |
dc.publisher | John Wiley & Sons, Inc. | - |
dc.relation.isformatof | Reproducció del document publicat a: https://doi.org/10.1002/hep.30885 | - |
dc.relation.ispartof | Hepatology 2020, vol.71, num. 3, p. 1023-1036 | - |
dc.relation.uri | https://doi.org/10.1002/hep.30885 | - |
dc.rights | cc-by-nc-nd (c) Mandorfer et al., 2020 | - |
dc.rights.uri | http://creativecommons.org/licenses/by-nc-nd/3.0/es/ | * |
dc.source | Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer) | - |
dc.subject.classification | Cirrosi hepàtica | - |
dc.subject.classification | Hipertensió | - |
dc.subject.classification | Interferó | - |
dc.subject.other | Hepatic cirrhosis | - |
dc.subject.other | Hypertension | - |
dc.subject.other | Interferon | - |
dc.title | Changes in Hepatic Venous Pressure Gradient Predict Hepatic Decompensation in Patients Who Achieved Sustained Virologic Response to Interferon-Free Therapy | - |
dc.type | info:eu-repo/semantics/article | - |
dc.type | info:eu-repo/semantics/publishedVersion | - |
dc.date.updated | 2020-05-13T11:34:11Z | - |
dc.rights.accessRights | info:eu-repo/semantics/openAccess | - |
dc.identifier.idimarina | 5900106 | - |
dc.identifier.pmid | 31365764 | - |
Appears in Collections: | Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer) |
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12474_5900106_16545960.pdf | 623.21 kB | Adobe PDF | View/Open |
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