The prognostic role of hepatic venous pressure gradient in cirrhotic patients undergoing elective extrahepatic surgery

Background & Aims: Surgery in cirrhosis is associated with a high morbidity and mortality. Retrospectively reported prognostic factors include emergency procedures, liver function (MELD/Child-Pugh scores) and portal hypertension (assessed by indirect markers). This study assessed the prognostic...

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Autores: Reverter, Enric, Cirera, Isabel, Albillos, Agustín, Debernardi-Venon, Wilma, Abraldes, Juan G., Llop, Elba, Flores, Alexandra, Martínez Palli, Graciela, Blasi Ibáñez, Annabel, Martínez González, Javier, Turon, Fanny, García-Valdecasas Salgado, Juan Carlos, Berzigotti, Annalisa, Lacy Fortuny, Antonio Ma. de, Fuster Obregón, Josep, Hernández Gea, Virginia, Bosch i Genover, Jaume, García Pagán, Juan Carlos
Tipo de recurso: artículo
Estado:Versión aceptada para publicación
Fecha de publicación:2019
País:España
Institución:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/147241
Acceso en línea:https://hdl.handle.net/2445/147241
Access Level:acceso abierto
Palabra clave:Pressió venosa
Cirrosi hepàtica
Mortalitat
Venous pressure
Hepatic cirrhosis
Mortality
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spelling The prognostic role of hepatic venous pressure gradient in cirrhotic patients undergoing elective extrahepatic surgeryReverter, EnricCirera, IsabelAlbillos, AgustínDebernardi-Venon, WilmaAbraldes, Juan G.Llop, ElbaFlores, AlexandraMartínez Palli, GracielaBlasi Ibáñez, AnnabelMartínez González, JavierTuron, FannyGarcía-Valdecasas Salgado, Juan CarlosBerzigotti, AnnalisaLacy Fortuny, Antonio Ma. deFuster Obregón, JosepHernández Gea, VirginiaBosch i Genover, JaumeGarcía Pagán, Juan CarlosPressió venosaCirrosi hepàticaMortalitatVenous pressureHepatic cirrhosisMortalityBackground & Aims: Surgery in cirrhosis is associated with a high morbidity and mortality. Retrospectively reported prognostic factors include emergency procedures, liver function (MELD/Child-Pugh scores) and portal hypertension (assessed by indirect markers). This study assessed the prognostic role of hepatic venous pressure gradient (HVPG) and other variables in elective extrahepatic surgery in patients with cirrhosis. Methods: A total of 140 patients with cirrhosis (Child-Pugh A/B/C: 59/37/4%), who were due to have elective extrahepatic surgery (121 abdominal; 9 cardiovascular/thoracic; 10 orthopedic and others), were prospectively included in 4 centers (2002–2011). Hepatic and systemic hemodynamics (HVPG, indocyanine green clearance, pulmonary artery catheterization) were assessed prior to surgery, and clinical and laboratory data were collected. Patients were followed-up for 1 year and mortality, transplantation, morbidity and post-surgical decompensation were studied. Results: Ninety-day and 1-year mortality rates were 8% and 17%, respectively. Variables independently associated with 1-year mortality were ASA class (American Society of Anesthesiologists), high-risk surgery (defined as open abdominal and cardiovascular/thoracic) and HVPG. These variables closely predicted 90-, 180- and 365-day mortality (C-statistic >0.8). HVPG values >16 mmHg were independently associated with mortality and values ≥20 mmHg identified a subgroup at very high risk of death (44%). Twenty-four patients presented persistent or de novo decompensation at 3 months. Low body mass index, Child-Pugh class and high-risk surgery were associated with death or decompensation. No patient with HVPG <10 mmHg or indocyanine green clearance >0.63 developed decompensation. Conclusions: ASA class, HVPG and high-risk surgery were prognostic factors of 1-year mortality in cirrhotic patients undergoing elective extrahepatic surgery. HVPG values >16 mmHg, especially ≥20 mmHg, were associated with a high risk of post-surgical mortality. Lay summary: The hepatic venous pressure gradient is associated with outcomes in patients with cirrhosis undergoing elective extrahepatic surgery. It enables a better stratification of risk in these patients and provides the foundations for potential interventions to improve post-surgical outcomes.Elsevier2019info:eu-repo/semantics/articleinfo:eu-repo/semantics/acceptedVersionapplication/pdfhttps://hdl.handle.net/2445/147241Articles 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.jhep.2019.07.007Journal of Hepatology, 2019, vol. 71, num. 5, p. 942-950https://doi.org/10.1016/j.jhep.2019.07.007cc by-nc-nd (c) Elsevier, 2019http://creativecommons.org/licenses/by-nc-nd/3.0/es/info:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/1472412026-05-27T06:46:51Z
dc.title.none.fl_str_mv The prognostic role of hepatic venous pressure gradient in cirrhotic patients undergoing elective extrahepatic surgery
title The prognostic role of hepatic venous pressure gradient in cirrhotic patients undergoing elective extrahepatic surgery
spellingShingle The prognostic role of hepatic venous pressure gradient in cirrhotic patients undergoing elective extrahepatic surgery
Reverter, Enric
Pressió venosa
Cirrosi hepàtica
Mortalitat
Venous pressure
Hepatic cirrhosis
Mortality
title_short The prognostic role of hepatic venous pressure gradient in cirrhotic patients undergoing elective extrahepatic surgery
title_full The prognostic role of hepatic venous pressure gradient in cirrhotic patients undergoing elective extrahepatic surgery
title_fullStr The prognostic role of hepatic venous pressure gradient in cirrhotic patients undergoing elective extrahepatic surgery
title_full_unstemmed The prognostic role of hepatic venous pressure gradient in cirrhotic patients undergoing elective extrahepatic surgery
title_sort The prognostic role of hepatic venous pressure gradient in cirrhotic patients undergoing elective extrahepatic surgery
dc.creator.none.fl_str_mv Reverter, Enric
Cirera, Isabel
Albillos, Agustín
Debernardi-Venon, Wilma
Abraldes, Juan G.
Llop, Elba
Flores, Alexandra
Martínez Palli, Graciela
Blasi Ibáñez, Annabel
Martínez González, Javier
Turon, Fanny
García-Valdecasas Salgado, Juan Carlos
Berzigotti, Annalisa
Lacy Fortuny, Antonio Ma. de
Fuster Obregón, Josep
Hernández Gea, Virginia
Bosch i Genover, Jaume
García Pagán, Juan Carlos
author Reverter, Enric
author_facet Reverter, Enric
Cirera, Isabel
Albillos, Agustín
Debernardi-Venon, Wilma
Abraldes, Juan G.
Llop, Elba
Flores, Alexandra
Martínez Palli, Graciela
Blasi Ibáñez, Annabel
Martínez González, Javier
Turon, Fanny
García-Valdecasas Salgado, Juan Carlos
Berzigotti, Annalisa
Lacy Fortuny, Antonio Ma. de
Fuster Obregón, Josep
Hernández Gea, Virginia
Bosch i Genover, Jaume
García Pagán, Juan Carlos
author_role author
author2 Cirera, Isabel
Albillos, Agustín
Debernardi-Venon, Wilma
Abraldes, Juan G.
Llop, Elba
Flores, Alexandra
Martínez Palli, Graciela
Blasi Ibáñez, Annabel
Martínez González, Javier
Turon, Fanny
García-Valdecasas Salgado, Juan Carlos
Berzigotti, Annalisa
Lacy Fortuny, Antonio Ma. de
Fuster Obregón, Josep
Hernández Gea, Virginia
Bosch i Genover, Jaume
García Pagán, Juan Carlos
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Pressió venosa
Cirrosi hepàtica
Mortalitat
Venous pressure
Hepatic cirrhosis
Mortality
topic Pressió venosa
Cirrosi hepàtica
Mortalitat
Venous pressure
Hepatic cirrhosis
Mortality
description Background & Aims: Surgery in cirrhosis is associated with a high morbidity and mortality. Retrospectively reported prognostic factors include emergency procedures, liver function (MELD/Child-Pugh scores) and portal hypertension (assessed by indirect markers). This study assessed the prognostic role of hepatic venous pressure gradient (HVPG) and other variables in elective extrahepatic surgery in patients with cirrhosis. Methods: A total of 140 patients with cirrhosis (Child-Pugh A/B/C: 59/37/4%), who were due to have elective extrahepatic surgery (121 abdominal; 9 cardiovascular/thoracic; 10 orthopedic and others), were prospectively included in 4 centers (2002–2011). Hepatic and systemic hemodynamics (HVPG, indocyanine green clearance, pulmonary artery catheterization) were assessed prior to surgery, and clinical and laboratory data were collected. Patients were followed-up for 1 year and mortality, transplantation, morbidity and post-surgical decompensation were studied. Results: Ninety-day and 1-year mortality rates were 8% and 17%, respectively. Variables independently associated with 1-year mortality were ASA class (American Society of Anesthesiologists), high-risk surgery (defined as open abdominal and cardiovascular/thoracic) and HVPG. These variables closely predicted 90-, 180- and 365-day mortality (C-statistic >0.8). HVPG values >16 mmHg were independently associated with mortality and values ≥20 mmHg identified a subgroup at very high risk of death (44%). Twenty-four patients presented persistent or de novo decompensation at 3 months. Low body mass index, Child-Pugh class and high-risk surgery were associated with death or decompensation. No patient with HVPG <10 mmHg or indocyanine green clearance >0.63 developed decompensation. Conclusions: ASA class, HVPG and high-risk surgery were prognostic factors of 1-year mortality in cirrhotic patients undergoing elective extrahepatic surgery. HVPG values >16 mmHg, especially ≥20 mmHg, were associated with a high risk of post-surgical mortality. Lay summary: The hepatic venous pressure gradient is associated with outcomes in patients with cirrhosis undergoing elective extrahepatic surgery. It enables a better stratification of risk in these patients and provides the foundations for potential interventions to improve post-surgical outcomes.
publishDate 2019
dc.date.none.fl_str_mv 2019
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/2445/147241
url https://hdl.handle.net/2445/147241
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.jhep.2019.07.007
Journal of Hepatology, 2019, vol. 71, num. 5, p. 942-950
https://doi.org/10.1016/j.jhep.2019.07.007
dc.rights.none.fl_str_mv cc by-nc-nd (c) Elsevier, 2019
http://creativecommons.org/licenses/by-nc-nd/3.0/es/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc by-nc-nd (c) Elsevier, 2019
http://creativecommons.org/licenses/by-nc-nd/3.0/es/
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 15,301603

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