Prognostic value of virtual portal pressure gradient response in compensated cirrhotic patients treated with carvedilol

Abstract

Background and objectivesThis study aimed to assess the prognostic significance of virtual portal pressure gradient (vPPG) response to carvedilol in patients with compensated cirrhosis (CC).MethodsCC patients with high‐risk varices were prospectively‐enrolled to give carvedilol for prevention of 1st variceal hemorrhage (VH) and followed‐up for one year. The vPPG response was defined as a reduction of vPPG >10% from baseline after one‐month therapy. Logistic and Cox regression analyses were performed to identify independent predictors for vPPG response and first decompensation, respectively. Competitive risk models were constructed to predict disease progression, and validated using the C‐index, Kaplan‐Meier analysis, competitive risk analysis, and calibration curves.ResultsA total of 129 patients completed this study, of whom 56 (43.4%) achieved vPPG response and were referred as vPPG responders. Baseline vPPG, red color sign, model for end‐stage liver disease (MELD) score, serum monocyte chemoattractant protein‐1 (MCP‐1) and laminin levels significantly correlated with vPPG response, which itself was further documented as an independent predictor of VH, ascites, and overall decompensation events in CC. Moreover, the red color sign or Child‐Turcotte‐Pugh score effectively predicted VH, while ascites correlated well with portal flow velocity or MCP‐1. The predictive models for VH and ascites showed a good discrimination with C‐index values of 0.747 and 0.689 respectively, and the high consistency on calibration curves.ConclusionsThe vPPG response could be used as a non‐invasive tool for prediction of disease progression in patients with CC.This article is protected by copyright. All rights reserved.