Hepatic venous pressure gradient and rebleeding risk of patients with nonalcoholic steatohepatitis cirrhosis after variceal bleeding

Yiqi Shi; Wenyong Shen; Gang Xu; Xunzheng Wang; Bo Ning

doi:10.3389/fmed.2023.1224506

Hepatic venous pressure gradient and rebleeding risk of patients with nonalcoholic steatohepatitis cirrhosis after variceal bleeding

Front Med (Lausanne). 2023 Jul 25:10:1224506. doi: 10.3389/fmed.2023.1224506. eCollection 2023.

Authors

Yiqi Shi¹, Wenyong Shen², Gang Xu², Xunzheng Wang³, Bo Ning¹

Affiliations

¹ Digestive System Department, Yuzhong Hospital of the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
² Digestive System Department, Chongqing Fuling Central Hospital of Chongqing University, Chongqing, China.
³ Digestive System Department, Jiangnan Hospital of the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Abstract

Background and aims: Hepatic venous pressure gradient (HVPG) has a strong predictive value for variceal rebleeding in cirrhotic patients, but the accuracy of HVPG may be compromised in nonalcoholic steatohepatitis (NASH) cirrhosis. This study aimed to evaluate the accuracy of HVPG and portal pressure gradient (PPG) for predicting rebleeding in NASH cirrhosis after acute variceal bleeding.

Patients and methods: Thirty-eight NASH cirrhosis patients and 82 hepatitis B virus (HBV) cirrhosis patients with acute variceal bleeding were included in this study. All patients recived transjugular intrahepatic portalsystemic shunt (TIPS). The prognostic value of HVPG and PPG for variceal rebleeding was evaluated.

Results: Compared with HBV cirrhosis, NASH cirrhosis demonstrated a lower HVPG (15.3 ± 3.8 vs. 18.0 ± 4.8; p = 0.003) and lower PPG (18.0 ± 3.7 vs. 20.0 ± 3.4; p = 0.005). HVPG (AUC = 0.82; p = 0.002) and PPG (AUC = 0.72; p = 0.027) had promising prognostic value among NASH cirrhosis patients. The optimal threshold of HVPG and PPG for predicting rebleeding in NASH cirrhosis was 17 mmHg and 20 mmHg. At multivariate analysis, HVPG ≥17 mmHg was a significant predictor of variceal rebleeding (HR 9.40; 95% CI 1.85-47.70; p = 0.007).

Conclusion: In the patients with cirrhosis and vairceal bleeding, the levels of HVPG and PPG were found to be low in NASH cirrhosis than HBV cirrhosis. However, the prevalence of rebleeding was similar between two groups. HVPG measurement is still an accurate way to assess the risk of variceal rebleeding in NASH cirrhosis.

Keywords: hepatic venous pressure gradient (HVPG); hepatitis B virus (HBV); nonalcoholic steatohepatitis (NASH); transjugular intrahepatic portosystemic shunt (TIPS); variceal bleeding.