Early portopulmonary hypertension predicts mortality in patients with cirrhosis: Insights from the PORTO-DETECT cohort

Background & Aims: Portopulmonary hypertension (PoPH) is a severe complication of cirrhosis and portal hypertension. In 2022, a European task force revised the diagnostic criteria for pulmonary arterial hypertension (PAH), defining early stages as a mean pulmonary arterial pressure (mPAP) of 20....

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Autores: Téllez, L, Donate, J, Guerrero, A, Beraza, IA, San Martín, D, Alvarado, E, Echevarria, V, Puente, A, Zamora, J, Del Prado, S, Tenes, A, Balagué, G, Vidal, B, Geli, C, Rodriguez-Gandia, MA, Baiges, A, Brujats, A, Rodríguez, DLH, Sánchez, SFG, Fortea, JI, del Cerro, MJ, Villanueva, C, Garcia-Pagán, JC, Giráldez, A, Albillos, A
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2026
País:España
Institución:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
Repositorio:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
OAI Identifier:oai:iibsantpau.fundanetsuite.com:p21117
Acceso en línea:https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=21117
Access Level:acceso abierto
Palabra clave:Cirrhosis
portopulmonary hypertension
HVPG
portal hypertension
pulmonary hypertension
heart failure
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spelling Early portopulmonary hypertension predicts mortality in patients with cirrhosis: Insights from the PORTO-DETECT cohortTéllez, LDonate, JGuerrero, ABeraza, IASan Martín, DAlvarado, EEchevarria, VPuente, AZamora, JDel Prado, STenes, ABalagué, GVidal, BGeli, CRodriguez-Gandia, MABaiges, ABrujats, ARodríguez, DLHSánchez, SFGFortea, JIdel Cerro, MJVillanueva, CGarcia-Pagán, JCGiráldez, AAlbillos, ACirrhosisportopulmonary hypertensionHVPGportal hypertensionpulmonary hypertensionheart failureBackground & Aims: Portopulmonary hypertension (PoPH) is a severe complication of cirrhosis and portal hypertension. In 2022, a European task force revised the diagnostic criteria for pulmonary arterial hypertension (PAH), defining early stages as a mean pulmonary arterial pressure (mPAP) of 20.5-24.5 mmHg and pulmonary vascular resistance (PVR) >2 Wood units. We evaluated the prognostic value of these revised criteria in patients with cirrhosis. Methods: In this longitudinal, multicenter, observational cohort, 428 adults with cirrhosis and portal hypertension underwent right-heart catheterization between 2015 and 2023 and were stratified into five groups: normal, early PoPH, classic PoPH, post-capillary pulmonary hypertension, and unclassified profiles. All-cause mortality was analyzed by multivariable Cox regression and competing-risk models, with liver transplantation as an intercurrent event. Results: Over a median follow-up time of 20.0 months (IQR 8.0-36.0), 3-year survival rates were 76.7%, 49.5%, and 42.0% in the normal mPAP, early PoPH, and classic PoPH groups, respectively. After adjustment for age, sex, liver function, and portal hypertension severity, both early PoPH (hazard ratio 3.5; 95% CI 1.9-6.3; p <0.01) and classic PoPH (hazard ratio 4.5; 2.6-7.6; p <0.01) remained independent predictors of mortality vs. normal mPAP; these associations persisted in competing-risk analysis, whereas post-capillary pulmonary hypertension and unclassified groups did not differ from the normal mPAP cohort. Conclusion: Applying the 2022 ESC/ERC definitions of PAH identifies a subset of patients with cirrhosis with early-stage PoPH, characterized by mild pulmonary vascular resistance elevation, who nevertheless face a markedly increased risk of death, emphasizing the need for systematic screening and early targeted intervention. (c) 2025 European Association for the Study of the Liver. Published by Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.ELSEVIER2026info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=21117JOURNAL OF HEPATOLOGYISSN: 01688278ISSNe: 16000641reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pauinstname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)Inglésinfo:eu-repo/semantics/openAccessoai:iibsantpau.fundanetsuite.com:p211172026-06-14T12:41:47Z
dc.title.none.fl_str_mv Early portopulmonary hypertension predicts mortality in patients with cirrhosis: Insights from the PORTO-DETECT cohort
title Early portopulmonary hypertension predicts mortality in patients with cirrhosis: Insights from the PORTO-DETECT cohort
spellingShingle Early portopulmonary hypertension predicts mortality in patients with cirrhosis: Insights from the PORTO-DETECT cohort
Téllez, L
Cirrhosis
portopulmonary hypertension
HVPG
portal hypertension
pulmonary hypertension
heart failure
title_short Early portopulmonary hypertension predicts mortality in patients with cirrhosis: Insights from the PORTO-DETECT cohort
title_full Early portopulmonary hypertension predicts mortality in patients with cirrhosis: Insights from the PORTO-DETECT cohort
title_fullStr Early portopulmonary hypertension predicts mortality in patients with cirrhosis: Insights from the PORTO-DETECT cohort
title_full_unstemmed Early portopulmonary hypertension predicts mortality in patients with cirrhosis: Insights from the PORTO-DETECT cohort
title_sort Early portopulmonary hypertension predicts mortality in patients with cirrhosis: Insights from the PORTO-DETECT cohort
dc.creator.none.fl_str_mv Téllez, L
Donate, J
Guerrero, A
Beraza, IA
San Martín, D
Alvarado, E
Echevarria, V
Puente, A
Zamora, J
Del Prado, S
Tenes, A
Balagué, G
Vidal, B
Geli, C
Rodriguez-Gandia, MA
Baiges, A
Brujats, A
Rodríguez, DLH
Sánchez, SFG
Fortea, JI
del Cerro, MJ
Villanueva, C
Garcia-Pagán, JC
Giráldez, A
Albillos, A
author Téllez, L
author_facet Téllez, L
Donate, J
Guerrero, A
Beraza, IA
San Martín, D
Alvarado, E
Echevarria, V
Puente, A
Zamora, J
Del Prado, S
Tenes, A
Balagué, G
Vidal, B
Geli, C
Rodriguez-Gandia, MA
Baiges, A
Brujats, A
Rodríguez, DLH
Sánchez, SFG
Fortea, JI
del Cerro, MJ
Villanueva, C
Garcia-Pagán, JC
Giráldez, A
Albillos, A
author_role author
author2 Donate, J
Guerrero, A
Beraza, IA
San Martín, D
Alvarado, E
Echevarria, V
Puente, A
Zamora, J
Del Prado, S
Tenes, A
Balagué, G
Vidal, B
Geli, C
Rodriguez-Gandia, MA
Baiges, A
Brujats, A
Rodríguez, DLH
Sánchez, SFG
Fortea, JI
del Cerro, MJ
Villanueva, C
Garcia-Pagán, JC
Giráldez, A
Albillos, A
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Cirrhosis
portopulmonary hypertension
HVPG
portal hypertension
pulmonary hypertension
heart failure
topic Cirrhosis
portopulmonary hypertension
HVPG
portal hypertension
pulmonary hypertension
heart failure
description Background & Aims: Portopulmonary hypertension (PoPH) is a severe complication of cirrhosis and portal hypertension. In 2022, a European task force revised the diagnostic criteria for pulmonary arterial hypertension (PAH), defining early stages as a mean pulmonary arterial pressure (mPAP) of 20.5-24.5 mmHg and pulmonary vascular resistance (PVR) >2 Wood units. We evaluated the prognostic value of these revised criteria in patients with cirrhosis. Methods: In this longitudinal, multicenter, observational cohort, 428 adults with cirrhosis and portal hypertension underwent right-heart catheterization between 2015 and 2023 and were stratified into five groups: normal, early PoPH, classic PoPH, post-capillary pulmonary hypertension, and unclassified profiles. All-cause mortality was analyzed by multivariable Cox regression and competing-risk models, with liver transplantation as an intercurrent event. Results: Over a median follow-up time of 20.0 months (IQR 8.0-36.0), 3-year survival rates were 76.7%, 49.5%, and 42.0% in the normal mPAP, early PoPH, and classic PoPH groups, respectively. After adjustment for age, sex, liver function, and portal hypertension severity, both early PoPH (hazard ratio 3.5; 95% CI 1.9-6.3; p <0.01) and classic PoPH (hazard ratio 4.5; 2.6-7.6; p <0.01) remained independent predictors of mortality vs. normal mPAP; these associations persisted in competing-risk analysis, whereas post-capillary pulmonary hypertension and unclassified groups did not differ from the normal mPAP cohort. Conclusion: Applying the 2022 ESC/ERC definitions of PAH identifies a subset of patients with cirrhosis with early-stage PoPH, characterized by mild pulmonary vascular resistance elevation, who nevertheless face a markedly increased risk of death, emphasizing the need for systematic screening and early targeted intervention. (c) 2025 European Association for the Study of the Liver. Published by Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
publishDate 2026
dc.date.none.fl_str_mv 2026
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=21117
url https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=21117
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv ELSEVIER
publisher.none.fl_str_mv ELSEVIER
dc.source.none.fl_str_mv JOURNAL OF HEPATOLOGY
ISSN: 01688278
ISSNe: 16000641
reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
instname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
instname_str Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
reponame_str r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
collection r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
repository.name.fl_str_mv
repository.mail.fl_str_mv
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