Assessment of short-term prognosis after variceal bleeding in patients with alcoholic cirrhosis by early measurement of portohepatic gradient.

Seventy-two consecutively admitted patients with biopsy-proven alcoholic cirrhosis and a bleeding episode endoscopically proven to originate from ruptured esophageal varices were studied. Hemodynamic assessment was performed within 48 hr of admission using the transjugular approach. Mean portal pressure was found to be significantly greater in the group of patients who died than in those who survived for 1 week, 2 weeks or 1 month after admission. We conclude that: The portohepatic pressure gradient and portal pressure have short-term prognostic value in patients with alcoholic cirrhosis bleeding from ruptured esophageal varices. Owing to a high early mortality, any delay between the occurrence of a bleeding episode and the measurement of portal pressure appears to select a sample of survivors with a significantly lower mean level of portal pressure than in those measured earlier. When evaluating portal pressure, the time of study is one of the most important variables which may affect the conclusions.