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

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

Keywords

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

ASJC Scopus subject areas

  • Hepatology

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