Prognostic value of acute hemodynamic response to i.v. propranolol in patients with cirrhosis and portal hypertension

Vincenzo La Mura, Juan G. Abraldes, Sebastian Raffa, Oswaldo Retto, Annalisa Berzigotti, Juan Carlos García-Pagán, Jaume Bosch

Research output: Contribution to journalArticle

75 Citations (Scopus)

Abstract

Background/Aims: Cirrhotic patients chronically treated with beta-blockers who achieve a decrease of hepatic venous pressure gradient (HVPG) ≥20% from baseline or to ≤12 mmHg have a marked reduction of first bleeding or re-bleeding. However, two HVPG measurements are needed to evaluate response. This study was aimed at investigating the predictive role of acute HVPG response to i.v. propranolol for bleeding and survival. Methods: We retrospectively studied 166 cirrhotic patients with varices with HVPG response to i.v. propranolol (0.15 mg/kg). All patients subsequently received non-selective beta-blockers to prevent first bleeding (n = 78) or re-bleeding (n = 88). Results: Thirty-seven patients developed a portal hypertension-related bleeding over 2 years of follow-up. Decrease (12%) in HVPG was the best cut-off for bleeding risk discrimination. This parameter was used to classify patients in responders (n = 95) and non-responders (n = 71). In primary prophylaxis (54 responders vs. 24 non-responders) the actuarial probability of bleeding was half in responders than in non-responders (12% vs. 23% at 2 years; ns). In secondary prophylaxis (41 responders vs. 47 non-responders) a good hemodynamic response was also significantly and independently associated with a 50% decrease in the probability of re-bleeding (23% at 2 years vs. 46% in non-responders; p = 0.032) and a better survival (95% vs. 65%; p = 0.003). Conclusion: The evaluation of acute HVPG response to i.v. propranolol before initiating secondary prophylaxis for variceal bleeding is a useful tool in predicting the efficacy of non-selective beta-blockers. If adequately validated, this might be a more cost-effective strategy than the chronic evaluation of HVPG response and might be useful to guide therapeutic decisions in these patients.

Original languageEnglish
Pages (from-to)279-287
Number of pages9
JournalJournal of Hepatology
Volume51
Issue number2
DOIs
Publication statusPublished - Aug 2009

Fingerprint

Portal Hypertension
Propranolol
Venous Pressure
Fibrosis
Hemodynamics
Hemorrhage
Liver
Survival
Varicose Veins
Costs and Cost Analysis

Keywords

  • Acute HVPG response
  • Cirrhosis
  • Non-selective beta-blockers
  • Portal hypertension

ASJC Scopus subject areas

  • Hepatology

Cite this

Prognostic value of acute hemodynamic response to i.v. propranolol in patients with cirrhosis and portal hypertension. / La Mura, Vincenzo; Abraldes, Juan G.; Raffa, Sebastian; Retto, Oswaldo; Berzigotti, Annalisa; García-Pagán, Juan Carlos; Bosch, Jaume.

In: Journal of Hepatology, Vol. 51, No. 2, 08.2009, p. 279-287.

Research output: Contribution to journalArticle

La Mura, Vincenzo ; Abraldes, Juan G. ; Raffa, Sebastian ; Retto, Oswaldo ; Berzigotti, Annalisa ; García-Pagán, Juan Carlos ; Bosch, Jaume. / Prognostic value of acute hemodynamic response to i.v. propranolol in patients with cirrhosis and portal hypertension. In: Journal of Hepatology. 2009 ; Vol. 51, No. 2. pp. 279-287.
@article{31560ac81f9643cfa57e218faada2450,
title = "Prognostic value of acute hemodynamic response to i.v. propranolol in patients with cirrhosis and portal hypertension",
abstract = "Background/Aims: Cirrhotic patients chronically treated with beta-blockers who achieve a decrease of hepatic venous pressure gradient (HVPG) ≥20{\%} from baseline or to ≤12 mmHg have a marked reduction of first bleeding or re-bleeding. However, two HVPG measurements are needed to evaluate response. This study was aimed at investigating the predictive role of acute HVPG response to i.v. propranolol for bleeding and survival. Methods: We retrospectively studied 166 cirrhotic patients with varices with HVPG response to i.v. propranolol (0.15 mg/kg). All patients subsequently received non-selective beta-blockers to prevent first bleeding (n = 78) or re-bleeding (n = 88). Results: Thirty-seven patients developed a portal hypertension-related bleeding over 2 years of follow-up. Decrease (12{\%}) in HVPG was the best cut-off for bleeding risk discrimination. This parameter was used to classify patients in responders (n = 95) and non-responders (n = 71). In primary prophylaxis (54 responders vs. 24 non-responders) the actuarial probability of bleeding was half in responders than in non-responders (12{\%} vs. 23{\%} at 2 years; ns). In secondary prophylaxis (41 responders vs. 47 non-responders) a good hemodynamic response was also significantly and independently associated with a 50{\%} decrease in the probability of re-bleeding (23{\%} at 2 years vs. 46{\%} in non-responders; p = 0.032) and a better survival (95{\%} vs. 65{\%}; p = 0.003). Conclusion: The evaluation of acute HVPG response to i.v. propranolol before initiating secondary prophylaxis for variceal bleeding is a useful tool in predicting the efficacy of non-selective beta-blockers. If adequately validated, this might be a more cost-effective strategy than the chronic evaluation of HVPG response and might be useful to guide therapeutic decisions in these patients.",
keywords = "Acute HVPG response, Cirrhosis, Non-selective beta-blockers, Portal hypertension",
author = "{La Mura}, Vincenzo and Abraldes, {Juan G.} and Sebastian Raffa and Oswaldo Retto and Annalisa Berzigotti and Garc{\'i}a-Pag{\'a}n, {Juan Carlos} and Jaume Bosch",
year = "2009",
month = "8",
doi = "10.1016/j.jhep.2009.04.015",
language = "English",
volume = "51",
pages = "279--287",
journal = "Journal of Hepatology",
issn = "0168-8278",
publisher = "Elsevier B.V.",
number = "2",

}

TY - JOUR

T1 - Prognostic value of acute hemodynamic response to i.v. propranolol in patients with cirrhosis and portal hypertension

AU - La Mura, Vincenzo

AU - Abraldes, Juan G.

AU - Raffa, Sebastian

AU - Retto, Oswaldo

AU - Berzigotti, Annalisa

AU - García-Pagán, Juan Carlos

AU - Bosch, Jaume

PY - 2009/8

Y1 - 2009/8

N2 - Background/Aims: Cirrhotic patients chronically treated with beta-blockers who achieve a decrease of hepatic venous pressure gradient (HVPG) ≥20% from baseline or to ≤12 mmHg have a marked reduction of first bleeding or re-bleeding. However, two HVPG measurements are needed to evaluate response. This study was aimed at investigating the predictive role of acute HVPG response to i.v. propranolol for bleeding and survival. Methods: We retrospectively studied 166 cirrhotic patients with varices with HVPG response to i.v. propranolol (0.15 mg/kg). All patients subsequently received non-selective beta-blockers to prevent first bleeding (n = 78) or re-bleeding (n = 88). Results: Thirty-seven patients developed a portal hypertension-related bleeding over 2 years of follow-up. Decrease (12%) in HVPG was the best cut-off for bleeding risk discrimination. This parameter was used to classify patients in responders (n = 95) and non-responders (n = 71). In primary prophylaxis (54 responders vs. 24 non-responders) the actuarial probability of bleeding was half in responders than in non-responders (12% vs. 23% at 2 years; ns). In secondary prophylaxis (41 responders vs. 47 non-responders) a good hemodynamic response was also significantly and independently associated with a 50% decrease in the probability of re-bleeding (23% at 2 years vs. 46% in non-responders; p = 0.032) and a better survival (95% vs. 65%; p = 0.003). Conclusion: The evaluation of acute HVPG response to i.v. propranolol before initiating secondary prophylaxis for variceal bleeding is a useful tool in predicting the efficacy of non-selective beta-blockers. If adequately validated, this might be a more cost-effective strategy than the chronic evaluation of HVPG response and might be useful to guide therapeutic decisions in these patients.

AB - Background/Aims: Cirrhotic patients chronically treated with beta-blockers who achieve a decrease of hepatic venous pressure gradient (HVPG) ≥20% from baseline or to ≤12 mmHg have a marked reduction of first bleeding or re-bleeding. However, two HVPG measurements are needed to evaluate response. This study was aimed at investigating the predictive role of acute HVPG response to i.v. propranolol for bleeding and survival. Methods: We retrospectively studied 166 cirrhotic patients with varices with HVPG response to i.v. propranolol (0.15 mg/kg). All patients subsequently received non-selective beta-blockers to prevent first bleeding (n = 78) or re-bleeding (n = 88). Results: Thirty-seven patients developed a portal hypertension-related bleeding over 2 years of follow-up. Decrease (12%) in HVPG was the best cut-off for bleeding risk discrimination. This parameter was used to classify patients in responders (n = 95) and non-responders (n = 71). In primary prophylaxis (54 responders vs. 24 non-responders) the actuarial probability of bleeding was half in responders than in non-responders (12% vs. 23% at 2 years; ns). In secondary prophylaxis (41 responders vs. 47 non-responders) a good hemodynamic response was also significantly and independently associated with a 50% decrease in the probability of re-bleeding (23% at 2 years vs. 46% in non-responders; p = 0.032) and a better survival (95% vs. 65%; p = 0.003). Conclusion: The evaluation of acute HVPG response to i.v. propranolol before initiating secondary prophylaxis for variceal bleeding is a useful tool in predicting the efficacy of non-selective beta-blockers. If adequately validated, this might be a more cost-effective strategy than the chronic evaluation of HVPG response and might be useful to guide therapeutic decisions in these patients.

KW - Acute HVPG response

KW - Cirrhosis

KW - Non-selective beta-blockers

KW - Portal hypertension

UR - http://www.scopus.com/inward/record.url?scp=67649224774&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=67649224774&partnerID=8YFLogxK

U2 - 10.1016/j.jhep.2009.04.015

DO - 10.1016/j.jhep.2009.04.015

M3 - Article

C2 - 19501930

AN - SCOPUS:67649224774

VL - 51

SP - 279

EP - 287

JO - Journal of Hepatology

JF - Journal of Hepatology

SN - 0168-8278

IS - 2

ER -