期刊
HEPATOLOGY COMMUNICATIONS
卷 6, 期 9, 页码 2569-2580出版社
JOHN WILEY & SONS LTD
DOI: 10.1002/hep4.2021
关键词
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资金
- Austrian Federal Ministry for Digital and Economic Affairs
- National Foundation for Research, Technology and Development
- Boehringer Ingelheim
- Christian Doppler Research Association
ACLD patients who have an acute hemodynamic response to intravenous propranolol have a lower risk of variceal bleeding and nonbleeding hepatic decompensation compared to nonresponders. Evaluation of the acute hemodynamic response to intravenous propranolol provides important prognostic information in ACLD.
Nonselective beta-blockers are used as prophylaxis for variceal bleeding in patients with advanced chronic liver disease (ACLD). The acute hemodynamic response to intravenous propranolol (i.e., >= 10% reduction in hepatic venous pressure gradient [HVPG]) is linked to a decreased risk of variceal bleeding. In this study, we aimed to investigate the overall prognostic value of an acute response in compensated and decompensated ACLD. We analyzed the long-term outcome of prospectively recruited patients with ACLD following a baseline HVPG measurement with an intraprocedural assessment of the acute hemodynamic response to propranolol. Overall, we included 98 patients with ACLD (mean +/- SD age, 56.4 +/- 11.5 years; 72.4% decompensated; 88.8% varices; mean +/- SD HVPG, 19.9 +/- 4.4 mm Hg) who were followed for a median of 9.6 (interquartile range, 6.5-18.2) months. Fifty-seven patients (58.2%) demonstrated an acute hemodynamic response to propranolol that was associated with a decreased risk of variceal bleeding (at 12 months, 3.6% vs. 15% in nonresponder; log-rank, p = 0.038) and hepatic decompensation (at 12 months, 23% vs. 33% in nonresponder; log-rank, p = 0.096). On multivariate analysis, the acute response was an independent predictor of first/further hepatic decompensation (adjusted hazards ratio, 0.31; 95% confidence interval [CI], 0.13-0.70; p = 0.005). Importantly, there was a tendency toward a prolonged transplant-free survival in acute responders compared to nonresponders (34.2; 95% CI, 29.2-39.2 vs. 25.2; 95% CI, 19.8-30.6 months; log-rank, p = 0.191). Conclusions: Patients with ACLD who achieve an acute hemodynamic response to intravenous propranolol experience a lower risk of variceal bleeding and nonbleeding hepatic decompensation events compared to nonresponders. An assessment of the acute hemodynamic response to intravenous propranolol provides important prognostic information in ACLD.
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