Application of a standardised protocol for hepatic venous pressure gradient measurement improves quality of readings and facilitates reduction of variceal bleeding in cirrhotics

作者：Tey Tze Tong; Gogna Apoorva; Irani Farah Gillan; Too Chow Wei; Lo Hoau Gong Richard; Tan Bien Soo; Tay Kiang Hiong; Lui Hock Foong; Chang Pik Eu Jason^*

来源：Singapore Medical Journal, 2016, 57(3): 132-137.

DOI：10.11622/smedj.2016054

• Asia
• hepatic venous pressure gradient
• quality
• Singapore
• variceal bleeding

INTRODUCTION Hepatic 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.
METHODS HVPG 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.
RESULTS 126 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).
CONCLUSION The 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.

• 出版日期2016-3