The prognostic value of HVPG-response to non-selective beta-blockers in patients with NASH cirrhosis and varices

作者：BS Hofer, Rafael Paternostro, Benedikt Simbrunner, Georg Semmler, Philipp Schwabl, B Scheiner, Theresa Bucsics, David Bauer, Michael Trauner, Mattias Mandorfer, Thomas Reiberger · 发表于：Zeitschrift für Gastroenterologie · 年份：2021 · DOI：10.1055/s-0041-1734327 · 被引用次数：4 · 研究领域：Liver Disease and Transplantation、Liver Disease Diagnosis and Treatment、Hepatocellular Carcinoma Treatment and Prognosis

Background & Aims With the global epidemic of obesity, non-alcoholic steatohepatitis (NASH) is becoming an increasingly relevant cause of cirrhosis. Non-selective beta-blockers (NSBB) are recommended for the prophylaxis of variceal bleeding. The prognostic value of a hepatic venous pressure gradient (HVPG)-guided NSBB prophylaxis remains to be investigated in the setting of NASH cirrhosis. Methods Patients with NASH cirrhosis and varices undergoing HVPG-guided NSBB therapy at the Vienna Hepatic Hemodynamic Lab were included. After the baseline HVPG measurement, the HVPG-response to NSBBs (decrease of ≥10 % from baseline or to HVPG<12mmHg) was evaluated within a median of 52 (IQR:28-71) days. The composite endpoint was defined as variceal bleeding, decompensation, and liver-related death. Results Thirty-eight patients were included: 69 % men, age: 59±12years, Child-A: 20 (52.6 %), Child-B: 13 (34.2 %), Child-C: 5 (13.2 %), median HVPG: 19.7±4.7mmHg. Seven patients (18.4 %) received propranolol (median dose: 80mg/d) and 31 (81.6 %) carvedilol (12.5mg/d). The mean HVPG-decrease was 26 % (p<0.001) and 21 (55.3 %) patients achieved an HVPG-response to NSBB. Absence of diabetes (aOR: 0.16; p = 0.038) and a higher baseline arterial blood pressure (aOR: 1.07; p = 0.044) predicted an NSBB-response. NSBB-HVPG-responders had fewer decompensations within 90 days than non-responders (n = 1 [5 %] vs. n = 3 [29 %]; log-rank p = 0.172). Child-Pugh stage (B: p = 0.001; C: p<0.001), MELD≥15 (p...