Single portal pressure measurement predicts survival in cirrhoticpatients with recent bleeding

Background—Height of portalpressure correlates with severity of alcoholic cirrhosis. Portalpressure indices are not however used routinely as predictors of survival.
Aims—To examine the clinical valueof a single portal pressure measurement in predicting outcome incirrhotic patients who have bled.
Methods—A series of 105 cirrhoticpatients who consecutively underwent hepatic venous pressuremeasurement were investigated. The main cause of cirrhosis wasalcoholic (64.8%) and prior to admission all patients had bled from varices.
Results—During the follow up period(median 566 days, range 10-2555), 33 patients died, and 54 developedvariceal haemorrhage. Applying Cox regression analysis, hepatic venouspressure gradient, bilirubin, prothrombin time, ascites, and previouslong term endoscopic treatment were the only statistically independentpredictors of survival, irrespective of cirrhotic aetiology. Thepredictive value of the pressure gradient was much higher if themeasurement was taken within the first or the second week from thebleeding and there was no association after 15 days. A hepatic venouspressure gradient of at least 16 mm Hg appeared to identify patientswith a greatly increased risk of dying.
Conclusions—Indirectly measuredportal pressure is an independent predictor of survival in patientswith both alcoholic and non-alcoholic cirrhosis. In patients with aprevious variceal bleeding episode this predictive value seems to bebetter if the measurement is taken within the first two weeks from thebleeding episode. A greater use of this technique is recommended forthe prognostic assessment and management of patients with chronic liver disease.

Keywords:chronic liver disease; alcoholic cirrhosis; portalpressure