Octavi Bassegoda1, Pol Olivas2, Laura Turco3, Mattias Mandorfer4, Miquel Serra-Burriel5, Luis Tellez6, Wilhelmus Kwanten7, Alexia Laroyenne8, Oana Farcau9, Edilmar Alvarado10, Lucile Moga11, Elise Vuille-Lessard12, Jose Ignacio Fortea13, Luis Ibañez14, Giulia Tosetti15, Thomas Vanwolleghem7, Hélène Larrue8, Diego Burgos-Santamaría16, Horia Stefanescu9, Rafael Paternostro4, Annalisa Cippitelli3, Sabela Lens1, Salvador Augustin17, Elba Llop18, Wim Laleman19, Jonel Trebicka20, Johannes Chang21, Helena Masnou22, Alexander Zipprich23, Francesca Miceli3, Georg Semmler4, Xavier Forns1, Massimo Primignani15, Rafael Bañares14, Angela Puente13, Annalisa Berzigotti12, Pierre Emmanuel Rautou11, Candid Villanueva10, Pere Ginès1, J C Garcia-Pagan2, Bogdan Procopet9, Cristophe Bureau8, Agustin Albillos6, Sven Francque7, Thomas Reiberger4, Filippo Schepis3, Isabel Graupera24, Virginia Hernandez-Gea25. 1. Liver Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain. 2. Liver Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Barcelona Hepatic Hemodynamic Laboratory, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver), Barcelona, Spain. 3. Division of Gastroenterology, Azienda Ospedaliero-Universitaria di Modena and University of Modena and Reggio Emilia, Modena, Italy. 4. Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria. 5. Epidemiology, Biostatistics, and Epidemiology Institute, University of Zurich, Zurich, Switzerland. 6. Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain. 7. Department of Gastroenterology and Hepatology, Antwerp University Hospital, Laboratory of Experimental Medicine and Pediatrics (LEMP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium. 8. Department of Hepato-gastroenterology, Purpan Hospital, CHU Toulouse, InSERM U858, University of Toulouse, Université Paul Sabatier, Toulouse, France. 9. Regional Institute of Gastroenterology and Hepatology "Octavian fodor", Hepatology Department and "luliu Hatieganu" University of Medicine and Pharmacy, 3rd Medical Clinic, Cluj-Napoca, Romania. 10. Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Servei de Patología Digestiva, Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat autònoma de Barcelona, Bellaterra, Barcelona, Spain. 11. Service d'Hépatologie, DMU Digest, Hôpital Beaujon, AP-HP, Clichy, France. 12. Hepatology, Inselspital, University Clinic of Visceral Surgery and Medicine (UVCM), University of Bern, Bern, Switzerland. 13. Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Gastroenterology and Hepatology Department, University Hospital Marqués de Valdecilla, Health Research Institute Marqués de Valdecilla (IDIVAL), Santander, Spain. 14. Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Servicio de Gastroenterología y hepatología, Hospital Gregorio Marañón, Madrid, España. 15. Division of Gastroenterology and Hepatology, Fundation IRCCS Ca´Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy. 16. Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain. 17. Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Institut de Recerca, Vall d'Hebron, Barcelona, Spain. 18. Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Liver Unit, Hospital U, Puerta de Hierro, Universidad Autònoma de Madrid, CIBERehd, Madrid, Spain. 19. Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium. 20. Translational Hepatology, Department of Internal Medicine I, Goethe University Clinic, Frankfurt, Germany. 21. Department of Internal Medicine I, University of Bonn, Bonn, Germany. 22. Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Hospital Universitari Germans Trias I Pujol, Universitat Autònoma de Barcelona, Badalona, Spain. 23. First Department of Internal Medicine, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany. 24. Liver Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain. Electronic address: igraupe@clinic.cat. 25. Liver Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Barcelona Hepatic Hemodynamic Laboratory, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver), Barcelona, Spain. Electronic address: vihernandez@clinic.cat.
Abstract
BACKGROUND & AIMS: Portal hypertension is the strongest predictor of hepatic decompensation and death in patients with cirrhosis. However, its discriminatory accuracy in patients with nonalcoholic fatty liver disease (NAFLD) has been challenged because hepatic vein catheterization may not reflect the real portal vein pressure as accurately as in patients with other etiologies. We aimed to evaluate the relationship between hepatic venous pressure gradient (HVPG) and presence of portal hypertension-related decompensation in patients with advanced NAFLD (aNAFLD). METHODS: Multicenter cross-sectional study included 548 patients with aNAFLD and 444 with advanced RNA-positive hepatitis C (aHCV) who had detailed portal hypertension evaluation (HVPG measurement, gastroscopy, and abdominal imaging). We examined the relationship between etiology, HVPG, and decompensation by logistic regression models. We also compared the proportions of compensated/decompensated patients at different HVPG levels. RESULTS: Both cohorts, aNAFLD and aHVC, had similar baseline age, gender, Child-Pugh score, and Model for End-Stage Liver Disease score. Median HVPG was lower in the aNAFLD cohort (13 vs 15 mmHg) despite similar liver function and higher rates of decompensation in aNAFLD group (32% vs 25%; P = .019) than in the aHCV group. For any of the HVPG cutoff analyzed (<10, 10-12, or 12 mmHg) the prevalence of decompensation was higher in the aNAFLD group than in the aHCV group. CONCLUSIONS: Patients with aNAFLD have higher prevalence of portal hypertension-related decompensation at any value of HVPG as compared with aHCV patients. Longitudinal studies aiming to identify HVPG thresholds able to predict decompensation and long-term outcomes in aNAFLD population are strongly needed.
BACKGROUND & AIMS: Portal hypertension is the strongest predictor of hepatic decompensation and death in patients with cirrhosis. However, its discriminatory accuracy in patients with nonalcoholic fatty liver disease (NAFLD) has been challenged because hepatic vein catheterization may not reflect the real portal vein pressure as accurately as in patients with other etiologies. We aimed to evaluate the relationship between hepatic venous pressure gradient (HVPG) and presence of portal hypertension-related decompensation in patients with advanced NAFLD (aNAFLD). METHODS: Multicenter cross-sectional study included 548 patients with aNAFLD and 444 with advanced RNA-positive hepatitis C (aHCV) who had detailed portal hypertension evaluation (HVPG measurement, gastroscopy, and abdominal imaging). We examined the relationship between etiology, HVPG, and decompensation by logistic regression models. We also compared the proportions of compensated/decompensated patients at different HVPG levels. RESULTS: Both cohorts, aNAFLD and aHVC, had similar baseline age, gender, Child-Pugh score, and Model for End-Stage Liver Disease score. Median HVPG was lower in the aNAFLD cohort (13 vs 15 mmHg) despite similar liver function and higher rates of decompensation in aNAFLD group (32% vs 25%; P = .019) than in the aHCV group. For any of the HVPG cutoff analyzed (<10, 10-12, or 12 mmHg) the prevalence of decompensation was higher in the aNAFLD group than in the aHCV group. CONCLUSIONS: Patients with aNAFLD have higher prevalence of portal hypertension-related decompensation at any value of HVPG as compared with aHCV patients. Longitudinal studies aiming to identify HVPG thresholds able to predict decompensation and long-term outcomes in aNAFLD population are strongly needed.