Role of hepatic hemodynamic study in the evaluation of patients with cirrhosis

To evaluate the levels of hepatic venous pressure gradient (HVPG) in a population of cirrhotic patients, checking if the 12 mmHg level discriminates those who bleed by rupture of gastroesophageal varices and assessing the prognostic role of hepatic venous pressure gradient in the progress of these patients.

Eighty-three cirrhotic patients (mean age 52.9 +/- 10.1 years) were studied, 71.1% of whom were males. All patients performed a hepatic hemodynamic study to determine the hepatic venous pressure gradient. Patients were followed 16.6 +/- 16.02 months on average.

Mean hepatic venous pressure gradient was 15.26 +/- 6.46 mmHg. The risk of bleeding was 50% for patients with hepatic venous pressure gradient below 12 mmHg and 76% (rr = 1.52, p = 0.045) for those with hepatic venous pressure gradient above 12 mmHg. When patients were grouped according to outcome (death, shunt surgery, transplantation, or rebleeding), the mean hepatic venous pressure gradient (16.65 +/- 6.71) was found to be significantly higher in these patients than in living patients without rebleeding (12.75 +/- 4.96), p = 0.014. However, the cutoff point of 16 mmHg failed to discriminate those patients with a worse prognosis.

Hepatic venous pressure gradient determination can be used to identify those individuals with a higher risk of bleeding due to rupture of gastroesophageal varices, as well as those with a more reserved prognosis, even though the discriminative critical levels used suggest that its clinical usefulness is relative.