Application of a standardised protocol for hepatic venous pressure gradient measurement improves quality of readings and facilitates reduction of variceal bleeding in cirrhotics.
- Author:
Tze Tong TEY
1
;
Apoorva GOGNA
2
;
Farah Gillan IRANI
2
;
Chow Wei TOO
2
;
Hoau Gong Richard LO
2
;
Bien Soo TAN
2
;
Kiang Hiong TAY
2
;
Hock Foong LUI
3
;
Pik Eu Jason CHANG
1
Author Information
- Publication Type:Journal Article
- Keywords: Asia; Singapore; hepatic venous pressure gradient; quality; variceal bleeding
- MeSH: Esophageal and Gastric Varices; complications; physiopathology; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; etiology; physiopathology; prevention & control; Humans; Hypertension, Portal; complications; physiopathology; Liver Cirrhosis; complications; physiopathology; Male; Middle Aged; Portal Pressure; physiology; Prognosis; Retrospective Studies
- From:Singapore medical journal 2016;57(3):132-137
- CountrySingapore
- Language:English
-
Abstract:
INTRODUCTIONHepatic venous pressure gradient (HVPG) measurement is recommended for prognostic and therapeutic indications in centres with adequate resources and expertise. Our study aimed to evaluate the quality of HVPG measurements at our centre before and after introduction of a standardised protocol, and the clinical relevance of the HVPG to variceal bleeding in cirrhotics.
METHODSHVPG measurements performed at Singapore General Hospital from 2005-2013 were retrospectively reviewed. Criteria for quality HVPG readings were triplicate readings, absence of negative pressure values and variability of ≤ 2 mmHg. The rate of variceal bleeding was compared in cirrhotics who achieved a HVPG response to pharmacotherapy (reduction of the HVPG to < 12 mmHg or by ≥ 20% of baseline) and those who did not.
RESULTS126 HVPG measurements were performed in 105 patients (mean age 54.7 ± 11.4 years; 55.2% men). 80% had liver cirrhosis and 20% had non-cirrhotic portal hypertension (NCPH). The mean overall HVPG was 13.5 ± 7.2 mmHg, with a significant difference between the cirrhosis and NCPH groups (p < 0.001). The proportion of quality readings significantly improved after the protocol was introduced. HVPG response was achieved in 28 (33.3%, n = 84) cirrhotics. Nine had variceal bleeding over a median follow-up of 29 months. The rate of variceal bleeding was significantly lower in HVPG responders compared to nonresponders (p = 0.025).
CONCLUSIONThe quality of HVPG measurements in our centre improved after the introduction of a standardised protocol. A HVPG response can prognosticate the risk of variceal bleeding in cirrhotics.
