The prognostic Role of hepatic venous pressure gradient in cirrhotic patients undergoing elective extrahepatic surgery

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• dc.contributor.author Reverter Enric
• dc.contributor.author Cirera Lorenzo, Isabel
• dc.contributor.author Albillos, Agustín
• dc.contributor.author Debernardi-Venon, Wilma
• dc.contributor.author Abraldes, Juan Gonzales
• dc.contributor.author Llop, Elba
• dc.contributor.author Flores, Alexandra
• dc.contributor.author Martínez-Palli, Graciela
• dc.contributor.author Blasi, Annabel
• dc.contributor.author Martínez, Javier
• dc.contributor.author Turon, Fanny
• dc.contributor.author García-Valdecasas, Juan Carlos
• dc.contributor.author Berzigotti, Annalisa
• dc.contributor.author de Lacy, Antoni María
• dc.contributor.author Fuster, Josep
• dc.contributor.author Hernández-Gea, Virginia
• dc.contributor.author Bosch Colom, Jaume, 1954-
• dc.contributor.author García-Pagán, Joan Carles
• dc.date.accessioned 2020-02-13T10:05:14Z
• dc.date.issued 2019
• dc.description.abstract Background & aims: Surgery in cirrhosis is associated with a high morbidity and mortality. Retrospectively reported prognostic factors include emergency procedures, liver function (MELD/Child-Pugh scores) and portal hypertension (assessed by indirect markers). This study assessed the prognostic role of hepatic venous pressure gradient (HVPG) and other variables in elective extrahepatic surgery in patients with cirrhosis. Methods: A total of 140 patients with cirrhosis (Child-Pugh A/B/C: 59/37/4%), who were due to have elective extrahepatic surgery (121 abdominal; 9 cardiovascular/thoracic; 10 orthopedic and others), were prospectively included in 4 centers (2002-2011). Hepatic and systemic hemodynamics (HVPG, indocyanine green clearance, pulmonary artery catheterization) were assessed prior to surgery, and clinical and laboratory data were collected. Patients were followed-up for 1 year and mortality, transplantation, morbidity and post-surgical decompensation were studied. Results: Ninety-day and 1-year mortality rates were 8% and 17%, respectively. Variables independently associated with 1-year mortality were ASA class (American Society of Anesthesiologists), high-risk surgery (defined as open abdominal and cardiovascular/thoracic) and HVPG. These variables closely predicted 90-, 180- and 365-day mortality (C-statistic >0.8). HVPG values >16 mmHg were independently associated with mortality and values ≥20 mmHg identified a subgroup at very high risk of death (44%). Twenty-four patients presented persistent or de novo decompensation at 3 months. Low body mass index, Child-Pugh class and high-risk surgery were associated with death or decompensation. No patient with HVPG <10 mmHg or indocyanine green clearance >0.63 developed decompensation. Conclusions: ASA class, HVPG and high-risk surgery were prognostic factors of 1-year mortality in cirrhotic patients undergoing elective extrahepatic surgery. HVPG values >16 mmHg, especially ≥20 mmHg, were associated with a high risk of post-surgical mortality.
• dc.description.sponsorship Supported in part by grants from Ministerio de Educacion yCiencia (SAF-2016-75767-R), and from Instituto de Salud CarlosIII (PIE 15/00027). CIBERehd is funded by Instituto de Salud Car-los III. ER was recipient of a Río Hortega award (2012–2014),Instituto de Salud Carlos III.
• dc.format.mimetype application/pdf
• dc.identifier.citation Reverter E, Cirera I, Albillos A, Debernardi-Venon W, Abraldes JG, Llop E. The prognostic Role of hepatic venous pressure gradient in cirrhotic patients undergoing elective extrahepatic surgery. J Hepatol. 2019 Nov;71(5):942-50. DOI: 10.1016/j.jhep.2019.07.007
• dc.identifier.doi http://dx.doi.org/10.1016/j.jhep.2019.07.007
• dc.identifier.issn 0168-8278
• dc.identifier.uri http://hdl.handle.net/10230/43589
• dc.language.iso eng
• dc.publisher Elsevier
• dc.relation.projectID info:eu-repo/grantAgreement/ES/1PE SAF-2016-75767-R
• dc.rights © Elsevier http://dx.doi.org/10.1016/j.jhep.2019.07.007
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.subject.keyword HVPG
• dc.subject.keyword Modeling
• dc.subject.keyword Portal hypertension
• dc.subject.keyword Post-operative complications
• dc.subject.keyword Prognosis
• dc.subject.keyword Surgical risk
• dc.title The prognostic Role of hepatic venous pressure gradient in cirrhotic patients undergoing elective extrahepatic surgery
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/acceptedVersion