caa a22 4500 445889047 CHVBK 20180317145609.0 cr unu---uuuuu 170323e20110501xx s 000 0 eng 10.1007/s00535-010-0360-z doi (NATIONALLICENCE)springer-10.1007/s00535-010-0360-z Prognostic value of a single HVPG measurement and Doppler-ultrasound evaluation in patients with cirrhosis and portal hypertension [Elektronische Daten] [Annalisa Berzigotti, Valentina Rossi, Carolina Tiani, Lucia Pierpaoli, Paola Zappoli, Anna Riili, Carla Serra, Pietro Andreone, Maria Morelli, Rita Golfieri, Cristina Rossi, Donatella Magalotti, Marco Zoli] Background: In patients with cirrhosis the onset of clinically significant portal hypertension (CSPH; i.e., hepatic venous pressure gradient (HVPG) ≥10mmHg) is associated with an increased risk of complications. However, most cirrhotic patients already have CSPH at presentation, and limited information is available on further risk stratification in this population. This study assessed the prognostic value of a single HVPG measurement and Doppler-ultrasound (US) evaluation in patients with cirrhosis and CSPH. Methods: Eighty-six consecutive patients with cirrhosis (73% compensated) and untreated CSPH (mean HVPG 17.8±5.1mmHg) were included. All were studied by paired HVPG and US, and followed up for a minimum of 12months (mean 28±20months). Results: Sixteen (25.3%) patients developed a first decompensation, and 11.6% died on follow-up. HVPG (per 1mmHg increase OR 1.22, 95% CI 1.05-1.40, p=0.007) and bilirubin (per 1mg/ml increase OR 2.42, 95% CI 0.93-6.26, p=0.06) independently predicted first decompensation, and Model for End-Stage Liver Disease (MELD) score (per 1 point increase OR 1.24, 95% CI 1.03-1.51, p=0.03) and HVPG (per 1mmHg increase OR 1.08, 95% CI 1.01-1.26, p=0.05) independently predicted mortality. The best HVPG cutoff predicting these events was 16mmHg. Ultrasonographic parameters lacked independent predictive value. The ultrasonographic detection of abdominal collaterals had a high positive likelihood ratio (7.03, 95% CI 2.23-22.16) for the prediction of HVPG ≥16mmHg, implying an increase of the probability of belonging to this higher-risk population from 58 to 91%. Conclusions: HVPG holds an independent predictive value for first decompensation and death in patients with CSPH. The ultrasonographic detection of collaterals allows the non-invasive identification of patients with HVPG ≥16mmHg, who are at higher risk. Springer, 2010 HVPG nationallicence Ultrasound nationallicence Porto-systemic shunts nationallicence Liver cirrhosis nationallicence Portal hypertension nationallicence HVPG : Hepatic venous pressure gradient nationallicence CSPH : Clinically significant portal hypertension nationallicence US : Ultrasound nationallicence APC : Abdominal porto-systemic collaterals nationallicence PUV : Paraumbilical vein nationallicence LGV : Left gastric vein nationallicence SR : Spleno-renal shunt nationallicence SGV : Short gastric veins nationallicence ROC : Receiver operating curve nationallicence Berzigotti Annalisa Department of Internal Medicine, Ageing and Nephrology, University of Bologna, Policlinico S. Orsola-Malpighi, Via Albertoni 15, 40138, Bologna, Italy aut Rossi Valentina Department of Internal Medicine, Ageing and Nephrology, University of Bologna, Policlinico S. Orsola-Malpighi, Via Albertoni 15, 40138, Bologna, Italy aut Tiani Carolina Department of Internal Medicine, Ageing and Nephrology, University of Bologna, Policlinico S. Orsola-Malpighi, Via Albertoni 15, 40138, Bologna, Italy aut Pierpaoli Lucia Department of Internal Medicine, Ageing and Nephrology, University of Bologna, Policlinico S. Orsola-Malpighi, Via Albertoni 15, 40138, Bologna, Italy aut Zappoli Paola Department of Internal Medicine, Ageing and Nephrology, University of Bologna, Policlinico S. Orsola-Malpighi, Via Albertoni 15, 40138, Bologna, Italy aut Riili Anna Department of Gastroenterology and Internal Medicine, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy aut Serra Carla Department of Gastroenterology and Internal Medicine, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy aut Andreone Pietro Department of Gastroenterology and Internal Medicine, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy aut Morelli Maria Department of Gastroenterology and Internal Medicine, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy aut Golfieri Rita Department of Gastroenterology and Internal Medicine, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy aut Rossi Cristina Department of Hematology, Oncology and Laboratory Medicine, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy aut Magalotti Donatella Department of Internal Medicine, Ageing and Nephrology, University of Bologna, Policlinico S. Orsola-Malpighi, Via Albertoni 15, 40138, Bologna, Italy aut Zoli Marco Department of Internal Medicine, Ageing and Nephrology, University of Bologna, Policlinico S. Orsola-Malpighi, Via Albertoni 15, 40138, Bologna, Italy aut Journal of Gastroenterology Springer Japan 46/5(2011-05-01), 687-695 0944-1174 46:5<687 2011 46 535 https://doi.org/10.1007/s00535-010-0360-z text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00535-010-0360-z text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Berzigotti Annalisa Department of Internal Medicine, Ageing and Nephrology, University of Bologna, Policlinico S. Orsola-Malpighi, Via Albertoni 15, 40138, Bologna, Italy aut NATIONALLICENCE 700 1- Rossi Valentina Department of Internal Medicine, Ageing and Nephrology, University of Bologna, Policlinico S. Orsola-Malpighi, Via Albertoni 15, 40138, Bologna, Italy aut NATIONALLICENCE 700 1- Tiani Carolina Department of Internal Medicine, Ageing and Nephrology, University of Bologna, Policlinico S. Orsola-Malpighi, Via Albertoni 15, 40138, Bologna, Italy aut NATIONALLICENCE 700 1- Pierpaoli Lucia Department of Internal Medicine, Ageing and Nephrology, University of Bologna, Policlinico S. Orsola-Malpighi, Via Albertoni 15, 40138, Bologna, Italy aut NATIONALLICENCE 700 1- Zappoli Paola Department of Internal Medicine, Ageing and Nephrology, University of Bologna, Policlinico S. Orsola-Malpighi, Via Albertoni 15, 40138, Bologna, Italy aut NATIONALLICENCE 700 1- Riili Anna Department of Gastroenterology and Internal Medicine, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy aut NATIONALLICENCE 700 1- Serra Carla Department of Gastroenterology and Internal Medicine, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy aut NATIONALLICENCE 700 1- Andreone Pietro Department of Gastroenterology and Internal Medicine, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy aut NATIONALLICENCE 700 1- Morelli Maria Department of Gastroenterology and Internal Medicine, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy aut NATIONALLICENCE 700 1- Golfieri Rita Department of Gastroenterology and Internal Medicine, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy aut NATIONALLICENCE 700 1- Rossi Cristina Department of Hematology, Oncology and Laboratory Medicine, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy aut NATIONALLICENCE 700 1- Magalotti Donatella Department of Internal Medicine, Ageing and Nephrology, University of Bologna, Policlinico S. Orsola-Malpighi, Via Albertoni 15, 40138, Bologna, Italy aut NATIONALLICENCE 700 1- Zoli Marco Department of Internal Medicine, Ageing and Nephrology, University of Bologna, Policlinico S. Orsola-Malpighi, Via Albertoni 15, 40138, Bologna, Italy aut NATIONALLICENCE 773 0- Journal of Gastroenterology Springer Japan 46/5(2011-05-01), 687-695 0944-1174 46:5<687 2011 46 535 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer