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Abstract
Variceal bleeding is the most important complication of portal hypertension. However,
the relationship between the increase in portal pressure and the outcome of variceal
bleeding has not been well defined.
We measured the hepatic venous pressure gradient (HVPG) of 65 cirrhotic patients with
acute variceal hemorrhage, early after admission (20.6 +/- 15.6 hours).
Twenty-three patients had a poor evolution (failure to control bleeding or early variceal
rebleeding), and 42 had an uneventful evolution. The only variable associated with
outcome was the HVPG, which was higher in patients with a poor evolution (23.7 +/-
6.1 vs. 19.2 +/- 3.3 mm Hg; P < 0.0004). This was confirmed by multivariate analysis.
HVPG was >/=20 mm Hg in 19 of 23 patients with poor evolution vs. 12 of 42 patients
with uneventful evolution (P < 0.0001). An initial HVPG of >/=20 mm Hg was associated
with a significantly longer intensive care unit stay (7 +/- 5 vs. 4 +/- 2 days; P
< 0.02), longer hospital stay (19 +/- 10 vs. 14 +/- 6 days; P < 0.02), greater transfusion
requirements (9.0 +/- 7.7 vs. 4.7 +/- 3.2 UU; P < 0.007), and a worse actuarial probability
of survival (1-year mortality, 64% vs. 20%; P < 0.002).
Early measurement of HVPG in cirrhotic patients during acute variceal bleeding provides
useful prognostic information on the evolution of the bleeding episode and long-term
survival.