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Decompensation in Advanced Nonalcoholic Fatty Liver Disease May Occur at Lower Hepatic Venous Pressure Gradient Levels Than in Patients With Viral Disease |
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Clin Gastroenterol Hepatol. 2022 Oct;20(10):2276-2286.e6.doi: 10.1016/j.cgh.2021.10.023. Epub 2021 Oct 21.
Octavi Bassegoda 1, Pol Olivas 2, Laura Turco 3, Mattias Mandorfer 4, Miquel Serra-Burriel 5, Luis Tellez 6, Wilhelmus Kwanten 7, Alexia Laroyenne 8, Oana Farcau 9, Edilmar Alvarado 10, Lucile Moga 11, Elise Vuille-Lessard 12, Jose Ignacio Fortea 13, Luis Ibañez 14, Giulia Tosetti 15, Thomas Vanwolleghem 7, Hélène Larrue 8, Diego Burgos-Santamaría 16, Horia Stefanescu 9, Rafael Paternostro 4, Annalisa Cippitelli 3, Sabela Lens 1, Salvador Augustin 17, Elba Llop 18, Wim Laleman 19, Jonel Trebicka 20, Johannes Chang 21, Helena Masnou 22, Alexander Zipprich 23, Francesca Miceli 3, Georg Semmler 4, Xavier Forns 1, Massimo Primignani 15, Rafael Bañares 14, Angela Puente 13, Annalisa Berzigotti 12, Pierre Emmanuel Rautou 11, Candid Villanueva 10, Pere Ginès 1, J C Garcia-Pagan 2, Bogdan Procopet 9, Cristophe Bureau 8, Agustin Albillos 6, Sven Francque 7, Thomas Reiberger 4, Filippo Schepis 3, Isabel Graupera 24, Virginia Hernandez-Gea 25
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Author information
- 1Liver Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.
- 2Liver 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.
- 3Division of Gastroenterology, Azienda Ospedaliero-Universitaria di Modena and University of Modena and Reggio Emilia, Modena, Italy.
- 4Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
- 5Epidemiology, Biostatistics, and Epidemiology Institute, University of Zurich, Zurich, Switzerland.
- 6Centro 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.
- 7Department 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.
- 8Department of Hepato-gastroenterology, Purpan Hospital, CHU Toulouse, InSERM U858, University of Toulouse, Université Paul Sabatier, Toulouse, France.
- 9Regional Institute of Gastroenterology and Hepatology "Octavian fodor", Hepatology Department and "luliu Hatieganu" University of Medicine and Pharmacy, 3rd Medical Clinic, Cluj-Napoca, Romania.
- 10Centro 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.
- 11Service d'Hépatologie, DMU Digest, Hôpital Beaujon, AP-HP, Clichy, France.
- 12Hepatology, Inselspital, University Clinic of Visceral Surgery and Medicine (UVCM), University of Bern, Bern, Switzerland.
- 13Centro 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.
- 14Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Servicio de Gastroenterología y hepatología, Hospital Gregorio Marañón, Madrid, España.
- 15Division of Gastroenterology and Hepatology, Fundation IRCCS Ca´Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
- 16Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain.
- 17Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Institut de Recerca, Vall d'Hebron, Barcelona, Spain.
- 18Centro 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.
- 19Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.
- 20Translational Hepatology, Department of Internal Medicine I, Goethe University Clinic, Frankfurt, Germany.
- 21Department of Internal Medicine I, University of Bonn, Bonn, Germany.
- 22Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Hospital Universitari Germans Trias I Pujol, Universitat Autònoma de Barcelona, Badalona, Spain.
- 23First Department of Internal Medicine, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
- 24Liver 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.
- 25Liver 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.
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