Lowering Portal Pressure Improves Outcomes of Patients With Cirrhosis, With or Without Ascites: A Meta-Analysis

Background & Aims: In unselected patients with cirrhosis, those with reductions in hepatic venous pressure gradient (HVPG) to below a defined threshold (responders) have a reduced risk of variceal hemorrhage (VH) and death. We performed a meta-analysis to compare this effect in patients with vs...

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Autores: Turco, Laura, Villanueva, Càndid, Mura, Vincenzo La, García Pagán, Juan Carlos, Reiberger, Thomas, Genescà, Joan, Groszmann, Roberto J., Sharma, Barjesh C., Merkel, Carlo, Bureau, Christophe, Alvarado Tapias, Edilmar, González-Abraldes Iglesias, Juan, Albillos, Agustín, Bañares, Rafael, Peck-Radosavljevic, Markus, Augustin, Salvador, Sarin, Shiv K., Bosch, Jaime, García-Tsao, Guadalupe
Tipo de recurso: artículo
Estado:Versión aceptada para publicación
Fecha de publicación:2020
País:España
Institución:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/148219
Acceso en línea:https://hdl.handle.net/2445/148219
Access Level:acceso abierto
Palabra clave:Cirrosi hepàtica
Hipertensió portal
Hepatic cirrhosis
Portal hypertension
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spelling Lowering Portal Pressure Improves Outcomes of Patients With Cirrhosis, With or Without Ascites: A Meta-AnalysisTurco, LauraVillanueva, CàndidMura, Vincenzo LaGarcía Pagán, Juan CarlosReiberger, ThomasGenescà, JoanGroszmann, Roberto J.Sharma, Barjesh C.Merkel, CarloBureau, ChristopheAlvarado Tapias, EdilmarGonzález-Abraldes Iglesias, JuanAlbillos, AgustínBañares, RafaelPeck-Radosavljevic, MarkusAugustin, SalvadorSarin, Shiv K.Bosch, JaimeGarcía-Tsao, GuadalupeCirrosi hepàticaHipertensió portalHepatic cirrhosisPortal hypertensionBackground & Aims: In unselected patients with cirrhosis, those with reductions in hepatic venous pressure gradient (HVPG) to below a defined threshold (responders) have a reduced risk of variceal hemorrhage (VH) and death. We performed a meta-analysis to compare this effect in patients with vs without ascites. Methods: We collected data from 15 studies of primary or secondary prophylaxis of VH that reported data on VH and death in responders vs nonresponders. We included studies in which data on ascites at baseline and on other relevant outcomes during follow-up evaluation were available. We performed separate meta-analyses for patients with vs without ascites. Results: Of the 1113 patients included in the studies, 968 patients (87%) had been treated with nonselective β-blockers. In 993 patients (89%), HVPG response was defined as a decrease of more than 20% from baseline (>10% in 11% of patients) or to less than 12 mm Hg. In the 661 patients without ascites, responders (n = 329; 50%) had significantly lower odds of events (ascites, VH, or encephalopathy) than nonresponders (odds ratio [OR], 0.35; 95% CI, 0.22–0.56). Odds of death or liver transplantation were also significantly lower among responders than nonresponders (OR, 0.50, 95% CI, 0.32–0.78). In the 452 patients with ascites, responders (n = 188; 42%) had significantly lower odds of events (VH, refractory ascites, spontaneous bacterial peritonitis, or hepatorenal syndrome) than nonresponders (OR, 0.27; 95% CI, 0.16–0.43). Overall, odds of death or liver transplantation were lower among responders (OR, 0.47; 95% CI, 0.29–0.75). No heterogeneity was observed among studies. Conclusions: In a meta-analysis of clinical trials, we found that patients with cirrhosis with and without ascites who respond to treatment with nonselective β-blockers (based on reductions in HVPG) have a reduced risk of events, death, or liver transplantation.Elsevier2020info:eu-repo/semantics/articleinfo:eu-repo/semantics/acceptedVersionapplication/pdfhttps://hdl.handle.net/2445/148219Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésVersió postprint del document publicat a: https://doi.org/10.1016/j.cgh.2019.05.050Clinical Gastroenterology and Hepatology, 2020, vol. 18, num. 2, p. 313-327.e6https://doi.org/10.1016/j.cgh.2019.05.050(c) AGA Institute, 2020info:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/1482192026-05-27T06:46:51Z
dc.title.none.fl_str_mv Lowering Portal Pressure Improves Outcomes of Patients With Cirrhosis, With or Without Ascites: A Meta-Analysis
title Lowering Portal Pressure Improves Outcomes of Patients With Cirrhosis, With or Without Ascites: A Meta-Analysis
spellingShingle Lowering Portal Pressure Improves Outcomes of Patients With Cirrhosis, With or Without Ascites: A Meta-Analysis
Turco, Laura
Cirrosi hepàtica
Hipertensió portal
Hepatic cirrhosis
Portal hypertension
title_short Lowering Portal Pressure Improves Outcomes of Patients With Cirrhosis, With or Without Ascites: A Meta-Analysis
title_full Lowering Portal Pressure Improves Outcomes of Patients With Cirrhosis, With or Without Ascites: A Meta-Analysis
title_fullStr Lowering Portal Pressure Improves Outcomes of Patients With Cirrhosis, With or Without Ascites: A Meta-Analysis
title_full_unstemmed Lowering Portal Pressure Improves Outcomes of Patients With Cirrhosis, With or Without Ascites: A Meta-Analysis
title_sort Lowering Portal Pressure Improves Outcomes of Patients With Cirrhosis, With or Without Ascites: A Meta-Analysis
dc.creator.none.fl_str_mv Turco, Laura
Villanueva, Càndid
Mura, Vincenzo La
García Pagán, Juan Carlos
Reiberger, Thomas
Genescà, Joan
Groszmann, Roberto J.
Sharma, Barjesh C.
Merkel, Carlo
Bureau, Christophe
Alvarado Tapias, Edilmar
González-Abraldes Iglesias, Juan
Albillos, Agustín
Bañares, Rafael
Peck-Radosavljevic, Markus
Augustin, Salvador
Sarin, Shiv K.
Bosch, Jaime
García-Tsao, Guadalupe
author Turco, Laura
author_facet Turco, Laura
Villanueva, Càndid
Mura, Vincenzo La
García Pagán, Juan Carlos
Reiberger, Thomas
Genescà, Joan
Groszmann, Roberto J.
Sharma, Barjesh C.
Merkel, Carlo
Bureau, Christophe
Alvarado Tapias, Edilmar
González-Abraldes Iglesias, Juan
Albillos, Agustín
Bañares, Rafael
Peck-Radosavljevic, Markus
Augustin, Salvador
Sarin, Shiv K.
Bosch, Jaime
García-Tsao, Guadalupe
author_role author
author2 Villanueva, Càndid
Mura, Vincenzo La
García Pagán, Juan Carlos
Reiberger, Thomas
Genescà, Joan
Groszmann, Roberto J.
Sharma, Barjesh C.
Merkel, Carlo
Bureau, Christophe
Alvarado Tapias, Edilmar
González-Abraldes Iglesias, Juan
Albillos, Agustín
Bañares, Rafael
Peck-Radosavljevic, Markus
Augustin, Salvador
Sarin, Shiv K.
Bosch, Jaime
García-Tsao, Guadalupe
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Cirrosi hepàtica
Hipertensió portal
Hepatic cirrhosis
Portal hypertension
topic Cirrosi hepàtica
Hipertensió portal
Hepatic cirrhosis
Portal hypertension
description Background & Aims: In unselected patients with cirrhosis, those with reductions in hepatic venous pressure gradient (HVPG) to below a defined threshold (responders) have a reduced risk of variceal hemorrhage (VH) and death. We performed a meta-analysis to compare this effect in patients with vs without ascites. Methods: We collected data from 15 studies of primary or secondary prophylaxis of VH that reported data on VH and death in responders vs nonresponders. We included studies in which data on ascites at baseline and on other relevant outcomes during follow-up evaluation were available. We performed separate meta-analyses for patients with vs without ascites. Results: Of the 1113 patients included in the studies, 968 patients (87%) had been treated with nonselective β-blockers. In 993 patients (89%), HVPG response was defined as a decrease of more than 20% from baseline (>10% in 11% of patients) or to less than 12 mm Hg. In the 661 patients without ascites, responders (n = 329; 50%) had significantly lower odds of events (ascites, VH, or encephalopathy) than nonresponders (odds ratio [OR], 0.35; 95% CI, 0.22–0.56). Odds of death or liver transplantation were also significantly lower among responders than nonresponders (OR, 0.50, 95% CI, 0.32–0.78). In the 452 patients with ascites, responders (n = 188; 42%) had significantly lower odds of events (VH, refractory ascites, spontaneous bacterial peritonitis, or hepatorenal syndrome) than nonresponders (OR, 0.27; 95% CI, 0.16–0.43). Overall, odds of death or liver transplantation were lower among responders (OR, 0.47; 95% CI, 0.29–0.75). No heterogeneity was observed among studies. Conclusions: In a meta-analysis of clinical trials, we found that patients with cirrhosis with and without ascites who respond to treatment with nonselective β-blockers (based on reductions in HVPG) have a reduced risk of events, death, or liver transplantation.
publishDate 2020
dc.date.none.fl_str_mv 2020
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/acceptedVersion
format article
status_str acceptedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/148219
url https://hdl.handle.net/2445/148219
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Versió postprint del document publicat a: https://doi.org/10.1016/j.cgh.2019.05.050
Clinical Gastroenterology and Hepatology, 2020, vol. 18, num. 2, p. 313-327.e6
https://doi.org/10.1016/j.cgh.2019.05.050
dc.rights.none.fl_str_mv (c) AGA Institute, 2020
info:eu-repo/semantics/openAccess
rights_invalid_str_mv (c) AGA Institute, 2020
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Elsevier
publisher.none.fl_str_mv Elsevier
dc.source.none.fl_str_mv Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)
reponame:Dipòsit Digital de la UB
instname:Universidad de Barcelona
instname_str Universidad de Barcelona
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,300719

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