Portosystemic Pressure Gradient(PSPG) Measurement In Patients With Liver Cirrhosis

Objective:The aim of this study is to find the relation between portosystemic pressure gradient and clinical characteristics, endotoxin, endothelin, IL-1, IL-6 in liver cirrhosis patients with portal hypertension.Methods:We retrospected the data of 150 patients include portosystemic pressure gradient, CT portal venous angiography, esophageal varices, ascites, laboratory examination, medical history between Jan 2013 and Nov 2015. Based on medical history, the 150 patients were divided into two groups, one group include 50 patients who have never bleeding because of portal hypertension, another group include 100 patients who experienced at least once bleeding. We compared different methods to assess the probability of esophageal varices bleeding in patients with portal hypertension, include involved PSPG and other methods. We compared LPS levels in different groups for whether a patient undergo acute bleeding before procedures.Portal, hepatic and right atrial blood samples were measured from 30 patients with liver cirrhosis during and 7 days after transjugular intrahepatic portosystemic shunt (TIPS). LPS and ET-1 were measured by ELISA.Result:The bleeding group and no bleeding group were different in Child and MELDP score, the degree of esophageal varices, left gastric venous diameter, PSPG (P<0.05). the AUC-ROC (95% CI)of PSPG>16mmHg, left gastric venous diameter>6.5mm, the degree of esophageal varices is 0.796-0.97、0.691-0.865、 0.528-0.717.However, the AUC-ROC(95%CI) is 0.843-0.958 in the multi-factors centered on PSPG score. It shows that the multi-factors centered on PSPG score is better than others. The endotoxin level of most patients with acute bleeding is greater than 125 ng/L suggested the important role of LPS in patients with chronic liver cirrhosis. LPS and ET-1 levels were decreased in the portal vein after TIPS insertion. From the time before TIPS to 7 days after TIPS, The reduced level of portal venous LPS was correlated with the reduction in portal venous pressure gradient.Conclusion:A multi-factors centered on PSPG score may improve the accuracy of the assessment of the risk of esophageal varices bleeding. Higher LPS level in peripheral vein maybe have higher possibilities of acute esophageal varices bleeding in patients who have bleeding history at least once. Decreased PSPG may be an important factor in the reduction of the level of systemic inflammatory in patients after TIPS procedure.