Lowering Portal Pressure Improves Outcomes of Patients With Cirrhosis, With or Without Ascites: A Meta-Analysis - PubMed (original) (raw)
Meta-Analysis
. 2020 Feb;18(2):313-327.e6.
doi: 10.1016/j.cgh.2019.05.050. Epub 2019 Jun 5.
Candid Villanueva 2, Vincenzo La Mura [ 3](#full-view-affiliation-3 "Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda, Ospedale Maggiore Policlinico, Medicina Generale - Emostasi e Trombosi, Milano, Italy; Centro Ricerca e Cura "Angela Maria ed Antonio Migliavacca" per lo Studio e la Cura delle Malattie del Fegato and Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy."), Juan Carlos García-Pagán 4, Thomas Reiberger 5, Joan Genescà 6, Roberto J Groszmann 7, Barjesh C Sharma 8, Carlo Merkel 9, Christophe Bureau 10, Edilmar Alvarado 2, Juan Gonzalez Abraldes 11, Agustin Albillos 12, Rafael Bañares 13, Markus Peck-Radosavljevic 14, Salvador Augustin 6, Shiv K Sarin 8, Jaime Bosch 15, Guadalupe García-Tsao 16
Affiliations
- PMID: 31176013
- DOI: 10.1016/j.cgh.2019.05.050
Free article
Meta-Analysis
Lowering Portal Pressure Improves Outcomes of Patients With Cirrhosis, With or Without Ascites: A Meta-Analysis
Laura Turco et al. Clin Gastroenterol Hepatol. 2020 Feb.
Free article
Abstract
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.
Keywords: Hepatic Venous Pressure Gradient; NSBB; Outcome; Portal Hypertension.
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