| Objectives:Portal hypertension is the main complication of cirrhosis,it is also the main reason of the discompensated incidents such as varices and ascites.Hepatic venous pressure gradient(HVPG)is the gold criterion for determining portal hypertension and the efficacy of non-selective beta blockers(NSBBs)on decreasing portal pressure.HVPG response refers to a decrease of HVPG to below 12 mmHg or more than 10%.HVPG response can significantly decrease the possibility of variceal bleeding and other discompensated incidents.The study aims to analyze clinical factors that influence the response of HVPG to NSBBs,and the predictive value of these factors for response of HVPG.Methods:Cirrhosis patients with portal hypertension treated in the Department of Gastroenterology of Shandong Provincial Hospital and received HVPG measurements from April 2010 to November 2017 were reviewed retrospectively,and finally 104 patients were involved.The characteristics of patients were collected such as age,gender and other demographic characteristics,blood tests,radiographic manifestations,endoscopic manifestations,Child-Pugh scores and model of end-stage liver disease(MELD)scores,history of variceal bleeding,NSBBs,baseline values and repeated values of wedegd hepatic venous pressure gradient(WHVP),free hepatic venous pressure gradient(FHVP)and HVPG,and other clinical characteristics.All of these patients were grouped by responders and non-responders.Characteristics of responders and non-responders were compared in all groups.For factors that influence the response of HVPG dependently,the predictive value will be estimated by receiver operating characteristics curve(ROC)and the area under the curve(AUC).And to analyze the influence of different clinical factors,patients were also divided into subgroups according to etiology,presence of hepatocellular carcinoma,history of variceal bleeding,NSBBs,values of baseline HVPG:subgroup of patients caused by hepatic virus of B type(HBV),subgroup of patients without hepatocellular carcinoma,subgroup of patients without portal system thrombosis,subgroup of patients for primary prevention from variceal bleeding,subgroups of patients for secondary prevention from variceal bleeding,subgroup of patients received propranolol,subgroup of patients received carvedilol,subgroup of patients whose HVPG>16mmHg and subgroup of patients whose HVPG<16mmHg.All the statistical data were analyzed by SPSS21.0.Results:1.The level of serum potassium is higher in responders than non-responders(P=0.044),and serum potassium is an independent factor that influences the response of HVPG to NSBBs(P=0.05),but serum potassium cannot predict the response of HVPG specifically(AUC=0.617,P=0.051).2.For patients caused by HBV(n=64),the incidence of ascites in responders is higher than non-responders(P=0.038),and ascites is an independent factor that influences the response of HVPG(P=0.035),but ascites cannot predict the response of HVPG specifically(AUC=0.635,P=0.082).3.For patients without hepatocellular carcinoma(n=92),the MELD score and level of serum potassium in responders are higher than non-responders(P=0.043,0.024),and both of MELD score and level of serum potassium are independent factors that influence the response of HVPG(P=0.010,0.012),but MELD score and serum potassium cannot predict the response accurately(AUC=0.638,0.658,P=0.035,0.016).4.For patients without portal system thrombosis(n=69),there is no difference between the responders and non-responders(P>0.05).5.For patients for primary prevention from variceal bleeding(n=52),the level of serum potassium is higher in responders than non-responders(P=0.005),while the incidence of hepatocellular carcinoma is lower in responders than non-responders(P=0.043),also,serum potassium is an independent factor that influences the response of HVPG(P=0.006)and can predict the response of HVPG(AUC=0.778,P=0.002),the cut-off value is 3.95mmol/L,with a sensitivity of 60.6%,and a specificity of 93.3%.6.For patients for secondary prevention from variceal bleeding(n=52),the age of responders is older than non-responders(P=0.013)and age is an independent factor that influences the response of HVPG(P=0.020).Age can predict the predict the response of HVPG(AUC=0.705,P=0.012),the cut-off value is 45.5 years old,with a sensitivity of 83.3%and a specificity of 54.5%.7.For patients received propranolol(n=32),there is no difference between responders and non-responders(P>0.05).8.For subgroup of patients received carvedilol(n=72),the MELD score,International Normalized Ratio(INR),incidence of ascites and Child-Pugh classification are higher in responders than non-responders(P=0.016,0.046,0.043,0.044),and the incidence of hepatocellular carcinoma is lower in responders than non-responders.Hepatocellular carcinoma is the independent factor that influences the response of HVPG(P=0.028)but it cannot predict the response of HVPG(AUC=0.383,P=0.091).9.For patients with a HVPG<16mmHg(n=34),there is no difference between responders and non-responders(P>0.05).10,For patients with a HVPG≥16mmHg(n=70),Child-Pugh score,MELD score,level of serum potassium,INR,Prothrombin Time(PT),percentage of male are higher in responders than non-responders(P=0.047,0.005,0.049,0.011,0.032,0.022),and the incidence of hepatocellular carcinoma in responders is lower than non-responders.MELD score,level of serum potassium,PT INR are independent factors that influence the response of HVPG(P=0.022,0.034,0.027,0.046),but all of them have a poor ability to predict the response of HVPG(AUC=0.699,0.649,0.685,0.664,P=0.007,0.045,0.028,0.013).11.For all groups,there is no difference between responders and non-responders in alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),glutamyl transpeptidase(GGT),albumin(ALB),total bilirubin(TBIL),blood urea nitrogen(BUN),creatinine(CREA),white blood cell(WBC),hemoglobin(Hb),platelet(PLT),blood natrium(Na),grade of esophageal varices,gastric varices,red-sign,portal hypertensive gastropathy,baseline HVPG,baseline WHVP and baseline FHVP(P>0.05).Conclusions:1.For patients who are on primary prevention,serum potassium can predict the response of HVPG with with a sensitivity of 60.6%,and a specificity of 93.3%.For patients who are on secondary prevention,age can predict the response of HVPG with a sensitivity of 83.3%but a specificity of 54.4%.2.For patients caused by HBV,ascites is an independent factor that influences the response of HVPG.For patients without hepatocellular carcinoma,MELD score and serum potassium are independent factors that influence the response.For patients received carvedilol,hepatocellular carcinoma is an independent factor that influences the response of HVPG.For patients have an HVPG>16mmHg,MELD score,serum potassium,PT and INR are independent factors that influence the response of HVPG.3.The factors that influence the response of HVPG to NSBB are very complex,and there is no ideal indicators which are sensitive and specific to predict the response of HVPG. |
PDF Full Text Request