Metabolomics discloses potential biomarkers to predict the acute HVPG response to propranolol in patients with cirrhosis

Reverter, Enric; Lozano, Juan José; Alonso, Cristina; Berzigotti, Annalisa; Seijó, Susana; Turón, Fanny; Baiges, Anna; Martínez‐Chantar, M. Luz; Mato, José M.; Martínez‐Arranz, Ibon; Mura, Vincenzo La; Hernández‐Gea, Virginia; Bosch, Jaume; García‐Pagán, Juan Carlos

doi:10.1111/liv.14042

Cited by 20 publications

(16 citation statements)

References 40 publications

(81 reference statements)

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“…In addition, non-US elastography-based markers have been evaluated. Ras homolog family member A and Rho-kinase 2 transcription in the mucosa of the antrum (i.e., not a noninvasive marker in the strictest sense) 111 as well as phosphatidylcholine and eicosadienoic acid serum levels (AUROC: 0.801) 112 have been found to predict HVPG response to propranolol.…”

Section: Assessing Hepatic Venous Pressure Gradient Response To Nonsementioning

confidence: 99%

Noninvasive Diagnostics for Portal Hypertension: A Comprehensive Review

et al. 2020

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Noninvasive diagnostics for portal hypertension include imaging and functional tests, as well as blood-based biomarkers, and capture different features of the portal hypertensive syndrome. Definitive conclusions regarding their clinical utility require assessment of their diagnostic value in specific clinical settings (i.e., diagnosing a particular hemodynamic condition within a well-defined target population). Several noninvasive methods are predictive of clinically significant portal hypertension (CSPH; hepatic venous pressure gradient [HVPG] ≥ 10 mm Hg; the threshold for complications of portal hypertension); however, only a minority of them have been evaluated in compensated advanced chronic liver disease (i.e., the target population). Importantly, most methods correlate only weakly with HVPG at high values (i.e., in patients with CSPH). Nevertheless, selected methods show promise for diagnosing HVPG ≥ 16 mm Hg (the cut-off for increased risks of hepatic decompensation and mortality) and monitoring HVPG changes in response to nonselective beta-blockers or etiological treatments. Finally, we review established and potential future clinical applications of noninvasive methods.

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Section: Assessing Hepatic Venous Pressure Gradient Response To Nonsementioning

confidence: 99%

Noninvasive Diagnostics for Portal Hypertension: A Comprehensive Review

et al. 2020

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“…Interestingly, as performing HVPG measurements is not widely available, it should be noted that non-invasive methods are being studied in order to evaluate the response to NSBBs and to allow for optimisation of medical therapy without the need to perform HVPG measurements, 95,96 although none of these methods can replace HVPG at the moment.…”

Section: Key Pointmentioning

confidence: 99%

Precision medicine in variceal bleeding: Are we there yet?

Magaz

Baiges

Hernández‐Gea

2020

Journal of Hepatology

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Variceal bleeding is one of the most feared complications of portal hypertension in patients with cirrhosis because of its deleterious impact on prognosis. Adequate management of patients at risk of developing variceal bleeding includes the prevention of the first episode of variceal bleeding and rebleeding, and is crucial in modifying prognosis. The presence of clinically significant portal hypertension is the main factor determining the risk of development of varices and other liver-related decompensations; therefore, it should be carefully screened for and monitored. Treating patients with clinically significant portal hypertension based on their individual risk of portal hypertension-related bleeding undoubtedly improves prognosis. The evaluation of liver haemodynamics and liver function can stratify patients according to their risk of bleeding and are no question useful tools to guide therapy in an individualised manner. That said, recent data support the idea that tailoring therapy to patient characteristics may effectively impact on prognosis and increase survival in all clinical scenarios. This review will focus on evaluating the available evidence supporting the use of individual risk characteristics for clinical decision-making and their impact on clinical outcome and survival. In primary prophylaxis, identification and treatment of patients with clinically significant portal hypertension improves decompensation-free survival. In the setting of acute variceal bleeding, the risk of failure and rebleeding can be easily predicted, allowing for early escalation of treatment (i.e. pre-emptive transjugular intrahepatic portosystemic shunt) which can improve survival in appropriate candidates. Stratifying the risk of recurrent variceal bleeding based on liver function and haemodynamic response to non-selective betablockers allows for tailored treatment, thereby increasing survival and avoiding adverse events.

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“…In a pilot study, Reverter et al 94 presented a simple predictive model to identify HVPG‐responders to intravenous propranolol based on metabolomic serum analysis. They have identified several lipid substances, most of which were nonesterified fatty acids and glycerophospholipids (plasmalogens), at significantly different concentrations between HVPG‐responders and nonresponders.…”

Section: Primary Prevention Of Variceal Hemorrhagementioning

confidence: 99%

Primary prevention of bleeding from esophageal varices in patients with liver cirrhosis: An update and review of the literature

Garbuzenko

Arefyev

2020

J Evidence Based Medicine

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All patients with liver cirrhosis and portal hypertension should be stratified by risk groups to individualize different therapeutic strategies to increase the effectiveness of treatment. In this regard, the development of primary prophylaxis of variceal bleeding and its management according to the severity of portal hypertension may be promising. This paper is to describe the modern principles of primary prophylaxis of esophageal variceal bleeding in patients with liver cirrhosis. The PubMed and EMbase databases, Web of Science, Google Scholar, and the Cochrane Database of Systematic Reviews were used to search for relevant publications from 1999 to 2019. The results suggested that depending on the severity of portal hypertension, patients with cirrhosis should be divided into those who need preprimary prophylaxis, which aims to prevent the formation of esophageal varices, and those who require measures that aim to prevent esophageal variceal bleeding. In subclinical portal hypertension, therapy should be etiological and pathogenetic. Cirrhosis with clinically significant portal hypertension should receive nonselective β‐blockers if they have small esophageal varices and risk factors for variceal bleeding. Nonselective β‐blockers are the first‐line drugs for the primary prevention of bleeding from medium to large‐sized esophageal varices. Endoscopic band ligation is indicated for the patients who are intolerant to nonselective β‐blockers or in the case of contraindications to pharmacological therapy. In summary, the stratification of cirrhotic patients by the severity of portal hypertension and an individual approach to the choice of treatment may increase the effectiveness of therapy as well as improve survival rate of these patients.

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Metabolomics discloses potential biomarkers to predict the acute HVPG response to propranolol in patients with cirrhosis

Cited by 20 publications

References 40 publications

Noninvasive Diagnostics for Portal Hypertension: A Comprehensive Review

Noninvasive Diagnostics for Portal Hypertension: A Comprehensive Review

Precision medicine in variceal bleeding: Are we there yet?

Primary prevention of bleeding from esophageal varices in patients with liver cirrhosis: An update and review of the literature

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