Relationship between the hepatic venous pressure gradient and first variceal hemorrhage in patients with cirrhosis: a multicenter retrospective study in Korea

Abstract

Background/aims: Variceal hemorrhage is one of the major complications of cirrhosis and is associated with significant mortality and morbidity. The development of gastroesophageal varices and variceal hemorrhage is the most direct consequence of portal hypertension. Correlations between the hepatic venous pressure gradient (HVPG) and first variceal hemorrhage were examined.

Methods: Patients with cirrhosis who underwent HVPG measurement between July 2009 and September 2010 were enrolled (n=535). All patients underwent esophagogastroduodenoscopy to enable the evaluation of gastroesophageal varices.

Results: The HVPG for all patients was 16.46±7.05 mmHg (mean±SD), and was significantly higher among those with first variceal hemorrhage than in those without it. The HVPG was significantly correlated with both Child-Turcotte-Pugh (r=0.488, P<0.001) and Model for End-stage Liver Disease (r=0.478, P<0.001) scores. An HVPG value of 11 mmHg was predictive of first variceal hemorrhage with a sensitivity of 92.4% and a specificity of 27.7%.

Conclusions: The HVPG was higher in patients with first variceal hemorrhage than in those without it.

Keywords: Hepatic venous pressure gradient (HVPG); Variceal hemorrhage.

Figure 1

Hepatic venous pressure measurements made using hepatic vein catheterization. (A) The wedged hepatic venous pressure was measured upon inserting the catheter further into smaller branches of the hepatic veins, reflecting the intrahepatic portal vein pressure. (B) The free hepatic venous pressure was measured by inserting the catheter into the hepatic vein via the right jugular vein or the femoral vein.

Figure 2

The HVPG relative to varix size and type. (A) The HVPG was significantly higher in patients with large varices (F2, F3; 19.23±6.78 mmHg) than in those with small varices (F0, F1; 13.87±6.29 mmHg, P<0.001). (B) The HVPG differed significantly according to gastric varix type: absence, 15.98±7.14 mmHg; gastroesophageal varices (GOV)1 and GOV2, 18.03±6.68 mmHg; and isolated gastric varices, 15.00±2.83 mmHg (P=0.014).