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Measurement of the Hepatic Venous Pressure Gradient and Transjugular Liver Biopsy
07:10

Measurement of the Hepatic Venous Pressure Gradient and Transjugular Liver Biopsy

Published on: June 18, 2020

Prognostic indicators of survival in patients with compensated and decompensated cirrhosis

Alexander Zipprich1, Guadalupe Garcia-Tsao, Sebastian Rogowski

  • 1Department of Internal Medicine I, Martin-Luther-University Halle-Wittenberg, Halle, Germany. alexander.zipprich@medizin.uni-halle.de

Liver International : Official Journal of the International Association for the Study of the Liver
|June 12, 2012
PubMed

Insights

Survival and death predictors differ between compensated and decompensated cirrhosis. Hepatic venous pressure gradient (HVPG) is prognostic in compensated stages, while MELD score predicts mortality in decompensated stages.

Area of Science:

  • Hepatology
  • Clinical Medicine
  • Internal Medicine

Background:

  • Cirrhosis staging categorizes patients into compensated and decompensated stages.
  • Portal hypertension drives complications, marking the transition between cirrhosis stages.
  • Understanding survival and prognostic factors is crucial for patient management.

Purpose of the Study:

  • To analyze survival rates across different cirrhosis stages and substages.
  • To evaluate the prognostic value of hepatic venous pressure gradient (HVPG) in each cirrhosis stage.
  • To identify independent predictors of mortality in compensated and decompensated cirrhosis.

Main Methods:

  • A cohort of 729 patients with suspected cirrhosis underwent portal pressure and hemodynamic measurements.
  • Data collection for mortality occurred over a decade, with follow-up until November 2006.
  • Multivariable analysis identified predictors of death using two distinct models for each stage.

Main Results:

  • The study included 443 patients, with 1-year mortality of 5.4% (compensated) and 20.2% (decompensated).
  • Compensated patients without varices (stage 1) had better survival than those with varices (stage 2).
  • Age and HVPG (≥10 mmHg) predicted death in compensated cirrhosis; MELD score predicted death in decompensated cirrhosis.

Conclusions:

  • Survival and mortality predictors vary significantly between compensated and decompensated cirrhosis.
  • Ascites is a more effective clinical stratifier than variceal hemorrhage for decompensated cirrhosis.
  • Clinically significant portal hypertension, indicated by HVPG, holds prognostic value in compensated cirrhosis.
Abstract

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