Haemodynamic parameters predicting variceal haemorrhage and survival in alcoholic cirrhosis |
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Authors: | Stanley AJ; Robinson I; Forrest EH; Jones AL; Hayes PC |
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Institution: | Department of Medicine, Royal Infirmary of Edinburgh, UK. |
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Abstract: | The relationship between the various haemodynamic abnormalities observed in
cirrhosis and their prognostic value remains unclear. We report
haemodynamic measurements on 96 patients with alcoholic cirrhosis (mean
Childs-Pugh Score, CPS, 9.0 +/- 0.2, mean age 55.6 +/- 1.0 years) and
assess their value in predicting variceal bleeding and death during a mean
follow-up of 19.3 +/- 1.5 months. Baseline CPS correlated with hepatic
venous pressure gradient (HVPG) (p = 0.001), azygos blood flow (p <
0.05), cardiac index (p < 0.05), and inversely with mean arterial
pressure (p < 0.01) and systemic vascular resistance index (p <
0.05). Renal blood flow was not related to any haemodynamic parameter or
CPS. Thirty-eight patients died during follow-up, and 16 had a variceal
bleed. Death (p = 0.001) and variceal bleeding (p < 0.05) were more
likely in patients with HVPG > 16 mmHg than in those with HVPG < 16
mmHg, and variceal bleeding was more likely in patients with HVPG > 12
mmHg (vs. HVPG < 12 mmHg, p < 0.05). HVPG also predicted death and
variceal haemorrhage on univariate and multivariate analyses. No other
haemodynamic parameter predicted death or bleeding. In alcoholic cirrhosis,
severity of liver disease is related to HVPG, collateral blood flow and
degree of systemic circulatory abnormalities. HVPG is a useful predictor of
survival and variceal bleeding in these patients.
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