Hepatic venous pressure gradient predicts clinical decompensation in patients with compensated cirrhosis

Gastroenterology. 2007 Aug;133(2):481-8. doi: 10.1053/j.gastro.2007.05.024. Epub 2007 May 21.


Background and aims: Our aim was to identify predictors of clinical decompensation (defined as the development of ascites, variceal hemorrhage [VH], or hepatic encephalopathy [HE]) in patients with compensated cirrhosis and with portal hypertension as determined by the hepatic venous pressure gradient (HVPG).

Methods: We analyzed 213 patients with compensated cirrhosis and portal hypertension but without varices included in a trial evaluating the use of beta-blockers in preventing varices. All had baseline laboratory tests and HVPG. Patients were followed prospectively every 3 months until development of varices or VH or end of study. To have complete information, until study termination, about clinical decompensation, medical record review was done. Patients who underwent liver transplantation without decompensation were censored at transplantation. Cox regression models were developed to identify predictors of clinical decompensation. Receiver operating characteristic (ROC) curves were constructed to evaluate diagnostic capacity of HVPG.

Results: Median follow-up time of 51.1 months. Sixty-two (29%) of 213 patients developed decompensation: 46 (21.6%) ascites, 6 (3%) VH, 17 (8%) HE. Ten patients received a transplant and 12 died without clinical decompensation. Median HVPG at baseline was 11 mm Hg (range, 6-25 mm Hg). On multivariate analysis, 3 predictors of decompensation were identified: HVPG (hazard ratio [HR], 1.11; 95% confidence interval [CI], 1.05-1.17), model of end-stage liver disease (MELD) (HR, 1.15; 95% CI, 1.03-1.29), and albumin (HR, 0.37; 95% CI, 0.22-0.62). Diagnostic capacity of HVPG was greater than for MELD or Child-Pugh score.

Conclusions: HVPG, MELD, and albumin independently predict clinical decompensation in patients with compensated cirrhosis. Patients with an HVPG <10 mm Hg have a 90% probability of not developing clinical decompensation in a median follow-up of 4 years.

Publication types

  • Evaluation Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Ascites / etiology*
  • Ascites / mortality
  • Ascites / physiopathology
  • Esophageal and Gastric Varices / complications
  • Esophageal and Gastric Varices / etiology*
  • Esophageal and Gastric Varices / mortality
  • Esophageal and Gastric Varices / physiopathology
  • Female
  • Follow-Up Studies
  • Gastrointestinal Hemorrhage / etiology*
  • Gastrointestinal Hemorrhage / mortality
  • Gastrointestinal Hemorrhage / physiopathology
  • Hepatic Encephalopathy / etiology*
  • Hepatic Encephalopathy / mortality
  • Hepatic Encephalopathy / physiopathology
  • Humans
  • Hypertension, Portal / complications
  • Hypertension, Portal / diagnosis*
  • Hypertension, Portal / etiology
  • Hypertension, Portal / mortality
  • Hypertension, Portal / physiopathology
  • Kaplan-Meier Estimate
  • Liver Cirrhosis / complications*
  • Liver Cirrhosis / mortality
  • Liver Cirrhosis / physiopathology
  • Male
  • Middle Aged
  • Portal Pressure*
  • Predictive Value of Tests
  • Prognosis
  • Proportional Hazards Models
  • Prospective Studies
  • ROC Curve
  • Risk Assessment
  • Risk Factors
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Time Factors