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. 2016 Mar-Apr;22(2):109-15.
doi: 10.4103/1319-3767.164185.

Correlation of HVPG level with ctp score, MELD Score, ascites, size of varices, and etiology in cirrhotic patients

Subramaniam Ramanathan, Niranjan Khandelwal, Naveen Kalra  1 , Anmol Bhatia, Radha K Dhiman, Ajay K Duseja, Yogesh K Chawla
Affiliations

Correlation of HVPG level with ctp score, MELD Score, ascites, size of varices, and etiology in cirrhotic patients

Subramaniam Ramanathan et al. Saudi J Gastroenterol. 2016 Mar-Apr.

Abstract

Background/aim: This study intends to determine the correlation of a patient's hepatic venous pressure gradient (HVPG) measurement with six factors: Child-Turcotte-Pugh (CTP) score, model for end-stage liver disease (MELD) score, presence of ascites, size of varices, presence of variceal bleeding, and an etiology of cirrhosis. The study also aims to identify the predictors of higher HVPG measurements that can indirectly affect the prognosis of cirrhotic patients.

Patients and methods: Thirty patients diagnosed with cirrhosis were enrolled prospectively and each patient's HVPG level was measured by the transjugular catheterization of the right or middle hepatic vein. The wedged hepatic venous pressure (WHVP) and free hepatic venous pressure (FHVP) were measured using a 7F balloon catheter. The HVPG level was calculated as the difference between the WHVP and FHVP measurements.

Results: The mean HVPG level was higher in alcoholic than in nonalcoholic cirrhosis (19.5 ± 7.3 vs 15.2 ± 4.5 mm Hg, P = 0.13). The mean HVPG was also higher in bleeders compared with nonbleeders (18.5 ± 5.3 vs 10.7 ± 3.1 mmHg, P = 0.001). Patients with varices had a higher mean HVPG level than those without varices (17.4 ± 5.8 vs 11.7 ± 3.9 mmHg, P = 0.04). The difference among the three categories of varices (small, large, and no varices) was statistically significant (P = 0.03). In addition, the mean HVPG level was higher in patients with ascites than in those without ascites (18.7 ± 4.7 vs 11 ± 5.3 mmHg, P = 0.002), and it was significantly higher in patients in CTP class C (21.8 ± 5.5 mmHg) as compared with those in CTP class B (16.9 ± 2.9 mmHg) and CTP class A (10.5 ± 4.1 mmHg; P ≤ 0.001).

Conclusion: HVPG levels were significantly higher in patients in CTP class C as compared with those in CTP classes A and B, thereby indicating that an HVPG measurement correlates with severity of liver disease. A high HVPG level signifies more severe liver disease and can predict the major complications of cirrhosis.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Mean hepatic venous pressure gradient levels (mmHg) in patients with mild, severe, and no ascites
Figure 2
Figure 2
Mean hepatic venous pressure gradient levels (mmHg) in bleeders and nonbleeders
Figure 3
Figure 3
Mean hepatic venous pressure gradient levels (mmHg) in patients with small, large, and no varices
Figure 4
Figure 4
Mean hepatic venous pressure gradient (HVPG) levels (mmHg) in Child–Turcotte–Pugh (CTP) classes A, B, and C
Figure 5
Figure 5
Receiver operating characteristics curve showing the sensitivity and specificity for hepatic venous pressure gradient
See this image and copyright information in PMC

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