Lowering Portal Pressure Improves Outcomes of Patients With Cirrhosis, With or Without Ascites: A Meta-Analysis

Laura Turco, Candid Villanueva, Vincenzo La Mura, Juan Carlos García-Pagán, Thomas Reiberger, Joan Genescà, Roberto J. Groszmann, Barjesh C. Sharma, Carlo Merkel, Christophe Bureau, Edilmar Alvarado, Juan Gonzalez Abraldes, Agustin Albillos, Rafael Bañares, Markus Peck-Radosavljevic, Salvador Augustin, Shiv K. Sarin, Jaime Bosch, Guadalupe García-Tsao

Research output: Contribution to journalArticle

Abstract

Background & Aims: In unselected patients with cirrhosis, those with reductions in hepatic venous pressure gradient (HVPG) to below a defined threshold (responders) have a reduced risk of variceal hemorrhage (VH) and death. We performed a meta-analysis to compare this effect in patients with vs without ascites. Methods: We collected data from 15 studies of primary or secondary prophylaxis of VH that reported data on VH and death in responders vs nonresponders. We included studies in which data on ascites at baseline and on other relevant outcomes during follow-up evaluation were available. We performed separate meta-analyses for patients with vs without ascites. Results: Of the 1113 patients included in the studies, 968 patients (87%) had been treated with nonselective β-blockers. In 993 patients (89%), HVPG response was defined as a decrease of more than 20% from baseline (>10% in 11% of patients) or to less than 12 mm Hg. In the 661 patients without ascites, responders (n = 329; 50%) had significantly lower odds of events (ascites, VH, or encephalopathy) than nonresponders (odds ratio [OR], 0.35; 95% CI, 0.22–0.56). Odds of death or liver transplantation were also significantly lower among responders than nonresponders (OR, 0.50, 95% CI, 0.32–0.78). In the 452 patients with ascites, responders (n = 188; 42%) had significantly lower odds of events (VH, refractory ascites, spontaneous bacterial peritonitis, or hepatorenal syndrome) than nonresponders (OR, 0.27; 95% CI, 0.16–0.43). Overall, odds of death or liver transplantation were lower among responders (OR, 0.47; 95% CI, 0.29–0.75). No heterogeneity was observed among studies. Conclusions: In a meta-analysis of clinical trials, we found that patients with cirrhosis with and without ascites who respond to treatment with nonselective β-blockers (based on reductions in HVPG) have a reduced risk of events, death, or liver transplantation.

Original languageEnglish
Pages (from-to)313-327.e6
JournalClinical Gastroenterology and Hepatology
Volume18
Issue number2
DOIs
Publication statusPublished - Feb 2020

Keywords

  • Hepatic Venous Pressure Gradient
  • NSBB
  • Outcome
  • Portal Hypertension

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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    Turco, L., Villanueva, C., La Mura, V., García-Pagán, J. C., Reiberger, T., Genescà, J., Groszmann, R. J., Sharma, B. C., Merkel, C., Bureau, C., Alvarado, E., Abraldes, J. G., Albillos, A., Bañares, R., Peck-Radosavljevic, M., Augustin, S., Sarin, S. K., Bosch, J., & García-Tsao, G. (2020). Lowering Portal Pressure Improves Outcomes of Patients With Cirrhosis, With or Without Ascites: A Meta-Analysis. Clinical Gastroenterology and Hepatology, 18(2), 313-327.e6. https://doi.org/10.1016/j.cgh.2019.05.050