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Prognostic value of acute hemodynamic response to i.v. propranolol in patients with cirrhosis and portal hypertension.

Abstract：

BACKGROUND/AIMS:Cirrhotic patients chronically treated with beta-blockers who achieve a decrease of hepatic venous pressure gradient (HVPG) > or =20% from baseline or to < or =12 mmHg have a marked reduction of first bleeding or re-bleeding. However, two HVPG measurements are needed to evaluate response. This study was aimed at investigating the predictive role of acute HVPG response to i.v. propranolol for bleeding and survival. METHODS:We retrospectively studied 166 cirrhotic patients with varices with HVPG response to i.v. propranolol (0.15 mg/kg). All patients subsequently received non-selective beta-blockers to prevent first bleeding (n=78) or re-bleeding (n=88). RESULTS:Thirty-seven patients developed a portal hypertension-related bleeding over 2 years of follow-up. Decrease (12%) in HVPG was the best cut-off for bleeding risk discrimination. This parameter was used to classify patients in responders (n=95) and non-responders (n=71). In primary prophylaxis (54 responders vs. 24 non-responders) the actuarial probability of bleeding was half in responders than in non-responders (12% vs. 23% at 2 years; ns). In secondary prophylaxis (41 responders vs. 47 non-responders) a good hemodynamic response was also significantly and independently associated with a 50% decrease in the probability of re-bleeding (23% at 2 years vs. 46% in non-responders; p=0.032) and a better survival (95% vs. 65%; p=0.003). CONCLUSION:The evaluation of acute HVPG response to i.v. propranolol before initiating secondary prophylaxis for variceal bleeding is a useful tool in predicting the efficacy of non-selective beta-blockers. If adequately validated, this might be a more cost-effective strategy than the chronic evaluation of HVPG response and might be useful to guide therapeutic decisions in these patients.

journal_name

J Hepatol

journal_title

Journal of hepatology

authors

La Mura V,Abraldes JG,Raffa S,Retto O,Berzigotti A,García-Pagán JC,Bosch J

doi

10.1016/j.jhep.2009.04.015

subject

Has Abstract

pub_date

2009-08-01 00:00:00

pages

279-87

issue

2

eissn

0168-8278

issn

1600-0641

pii

S0168-8278(09)00311-0

journal_volume

51

pub_type

杂志文章

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