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http://hdl.handle.net/2445/160319
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DC Field | Value | Language |
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dc.contributor.author | Mura, Vincenzo La | - |
dc.contributor.author | Garcia Guix, Marta | - |
dc.contributor.author | Berzigotti, Annalisa | - |
dc.contributor.author | Abraldes, Juan G. | - |
dc.contributor.author | García Pagán, Juan Carlos | - |
dc.contributor.author | Villanueva, Candid | - |
dc.contributor.author | Bosch i Genover, Jaume | - |
dc.date.accessioned | 2020-05-14T17:22:57Z | - |
dc.date.available | 2021-01-20T06:10:21Z | - |
dc.date.issued | 2020-01-20 | - |
dc.identifier.issn | 1527-3350 | - |
dc.identifier.uri | http://hdl.handle.net/2445/160319 | - |
dc.description.abstract | Background & Aims: HVPG decrease ≥20% or ≤12mmHg (“responders”) indicates good prognosis during propranolol/nadolol treatment but requires two HVPG measurements. We aimed at simplifying risk‐stratification after variceal bleeding using clinical data and HVPG. Methods: 193 cirrhotic patients (62% with ascites and/or hepatic encephalopathy, HE) included within 7‐days of bleeding had HVPG measured before and at 1‐3 months of treatment with propranolol/nadolol plus endoscopic band ligation. End‐points: Rebleeding and rebleeding/transplantation‐free survival for 4‐years. Another cohort (n=231) served as validation set. Results: During follow‐up 45 patients had variceal bleeding and 61 died. HVPG‐responders (n=71) had lower rebleeding‐risk (10% vs 34%, p=0.001) and better survival than 122 non‐responders (61% vs 39%, p=0.001). Patients with/HE (n=120) had lower survival than patients without (40% vs 63%, p=0.005). Among patients with ascites/HE, those with baseline HVPG≤16mmHg (n=16) had low rebleeding‐risk (13%). By contrast, among patients with ascites/HE and baseline HVPG>16mmHg, only HVPG‐responders (n=32) had good prognosis, with lower rebleeding‐risk and better survival than non‐responders (n=72) (respective proportions: 7% vs 39%,p=0.018; 56% vs 30% p=0.010). These findings allowed developing a new algorithm for risk‐stratification in which HVPG‐response was only measured in patients with ascites and/or HE and baseline HVPG>16mmHg. This algorithm reduced the grey‐zone (high‐risk patients not dying on follow‐up) from 46% to 35% and decreased by 42% the HVPG measurements required. The validation cohort confirmed these results. Conclusion: Restricting HVPG measurements to patients with ascites/HE and measuring HVPG‐response only if baseline HVPG>16mmHg improves detection of high‐risk patients while markedly reducing the number of HVPG measurements required. | ca |
dc.format.extent | 28 p. | - |
dc.format.mimetype | application/pdf | - |
dc.language.iso | eng | ca |
dc.publisher | John Wiley & Sons, Inc. | ca |
dc.relation.isformatof | Versió postprint del document publicat a: https://doi.org/10.1002/hep.31125 | - |
dc.relation.ispartof | Hepatology, 2020 | - |
dc.relation.uri | https://doi.org/10.1002/hep.31125 | - |
dc.rights | (c) American Association for the Study of Liver Diseases, 2020 | - |
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.other | Hepatic cirrhosis | - |
dc.subject.other | Hypertension | - |
dc.title | A new prognostic algorithm based on stage of cirrhosis and HVPG to improve risk-stratification after variceal bleeding | ca |
dc.type | info:eu-repo/semantics/article | ca |
dc.type | info:eu-repo/semantics/acceptedVersion | - |
dc.date.updated | 2020-05-13T11:46:20Z | - |
dc.rights.accessRights | info:eu-repo/semantics/openAccess | - |
dc.identifier.idimarina | 6062419 | - |
dc.identifier.pmid | 31960441 | - |
Appears in Collections: | Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer) |
Files in This Item:
File | Description | Size | Format | |
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12474_6062419_259-_a_new_prognostic_algorithm_based_on_stage_of_cirrhosis.pdf | 918.38 kB | Adobe PDF | View/Open |
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