Hepatic venous pressure gradient and rebleeding risk of patients with nonalcoholic steatohepatitis cirrhosis after variceal bleeding

Abstract

Background & Aims Hepatic venous pressure gradient (HVPG) has a strong predictive value for variceal rebleeding in cirrhotic patients, but the accuracy of an HVPG may be compromised in nonalcoholic steatohepatitis (NASH) cirrhosis. This study aimed to evaluate the accuracy of HVPG and portal pressure gradient (PPG) for predicting rebleeding in NASH cirrhosis after acute variceal bleeding. Patients and Methods Thirty-eight NASH cirrhosis patients and 82 hepatitis B virus (HBV) cirrhosis patients with acute variceal bleeding were included in this study. All patients recived transjugular intrahepatic portalsystemic shunt (TIPS). The prognostic value of HVPG and PPG for variceal rebleeding was evaluated. Results Compared with HBV cirrhosis, NASH cirrhosis demonstrated a lower portal pressure (26.3 ± 6.1 vs. 30.1 ± 4.7; P <0.001), lower wedge hepatic venous pressure (24.1 ± 5.3 vs. 27.6 ± 5.5; P = 0.001) , lower HVPG (15.3 ± 3.8 vs. 18.0 ± 4.8; P = 0.003) and lower PPG (18.0 ± 3.7 vs. 20.0 ± 3.4; P = 0.005). HVPG (AUC = 0.82; P = 0.002) and PPG (AUC = 0.72;P = 0.027) had promising prognostic value among NASH cirrhosis patients. The optimal threshold of HVPG and PPG for predicting rebleeding in NASH cirrhosis was 17 mmHg and 20 mmHg. At multivariate analysis, an HVPG ≥17 mmHg was a significant predictor of variceal bleeding (HR 9.40; 95% CI 1.85-47.70; P = 0.007). Conclusions Patients with NASH cirrhosis had lower HVPG and lower PPG than those with HBV cirrhosis. However, the prevalence of rebleeding was similar between two groups. HVPG measurement is still an accurate way to assess the risk of variceal rebleeding in NASH cirrhosis.