Prognostic value of hepatic venous pressure gradient in patients with compensated chronic hepatitis C-related cirrhosis

Abstract

Background and aim. Hepatic venous pressure gradient (HVPG) is the main predictor of clinical decompensation in cirrhotic patients with compensated disease of any etiology without varices. However, the predictive factors of decompensation are not so well known in patients with hepatitis C-related compensated cirrhosis, in whom etiology-based therapy is difficult. The aim of this study was to identify predictors of decompensation in patients with compensated chronic hepatitis C (CHC)-related cirrhosis with and without esophageal varices (Baveno stages 1 and 2). Methods. The study population was a cohort of 145 of such consecutive patients who received hepatic hemodynamic study. All patients were similarly followed every 6 months. Through multivariate Cox regression and bootstrap analyses, a prognostic index (PI) was developed and tested in an external cohort (n = 38). Results. Forty-two patients (29%) suffered a first decompensation episode after a median follow-up of 27 months (2–110). Cox regression analysis identified HVPG (hazard ratio (HR) 1.11; 95% confidence interval (CI): 1.05–1.17) and albumin (HR 0.42; 95% CI: 0.22–0.82) as independent predictors of decompensation. Bootstrapping confirmed that HVPG (95% CI: 1.05–1.18) and albumin (95% CI: 0.12–0.74) were the most robust predictive variables. Using a cut-off level of 2.5, the PI [4 + (0.11 × HVPG - 0.8 × albumin)] was able to distinguish two populations of patients with very different risks of decompensation in both the exploratory and validation cohorts. A time-dependent ROC curve identified HVPG as the best predictive variable. Conclusion. HVPG and albumin are independent predictors of clinical decompensation in patients with compensated CHC-related cirrhosis irrespective of the existence of varices.

Key Words::

• chronic hepatitis C
• cirrhosis
• hepatic venous pressure gradient
• portal hypertension

Acknowledgement

Diego Rincón: study concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; statistical analysis; study supervision. Oreste lo Iacono: acquisition of data; analysis and interpretation of data. Marta Tejedor: acquisition of data. Ana Hernando: critical revision of the manuscript for important intellectual content. María-Vega Catalina: critical revision of the manuscript for important intellectual content. Magdalena Salcedo: critical revision of the manuscript for important intellectual content. Cristina Ripoll: critical revision of the manuscript for important intellectual content. Ana Matilla: critical revision of the manuscript for important intellectual content. María Senosiain: critical revision of the manuscript for important intellectual content. Gerardo Clemente: critical revision of the manuscript for important intellectual content. Luis-Miguel Molinero: statistical analysis; analysis and interpretation of data. Agustín Albillos: analysis and interpretation of data; drafting of the manuscript. Rafael Bañares: analysis and interpretation of data; drafting of the manuscript; statistical analysis; study supervision.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.