Hepatic venous pressure gradient can predict the development of hepatocellular carcinoma and hyponatremia in decompensated alcoholic cirrhosis

Objective Portal hypertension is closely associated with serious complications of cirrhosis, which contribute to bad prognosis. Hepatocellular carcinoma (HCC) and low serum sodium (SNa) are manifestations of end-stage liver disease and are associated with poor survival in decompensated cirrhosis patients. We aimed to determine the relationship between hepatic venous pressure gradient (HVPG) and the development of HCC or low SNa in decompensated alcoholic cirrhosis patients. Methods Child-Pugh scores, Model for End-Stage Liver Disease scores, and HVPG at baseline, and the development of HCC or low SNa (SNa < 130 mEq/l) during follow-up were analyzed prospectively in 170 patients with decompensated alcoholic cirrhosis from December 1999 to January 2008 (mean follow-up period of 33.9 +/- 27.9 months). The predictive value of different risk factors for the development of HCC and low SNa and survival were investigated. Results Twenty-four patients developed HCC during the follow-up period. In the multivariate analysis, only baseline HVPG greater than 15 mmHg was an independent predictive factor for the development of HCC (relative risk = 1.128, P < 0.05) and which showed a significantly shorter time for the development of HCC on the Kaplan-Meier analysis. Twenty patients developed low SNa during follow-up. Initial HVPG was also an independent predictive factor for the new development of low SNa in the multivariate analysis (relative risk = 1.169, P < 0.05) and which also showed significantly shorter times for the development of low SNa on the Kaplan-Meier analysis. Conclusion In decompensated alcoholic cirrhosis, HVPG may be a useful predictive factor for the development of HCC and low SNa. Eur J Gastroenterol Hepatol 21:1241-1246 (C) 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins.