Pre-transjugular-intrahepatic-portosystemic-shunt measurement of hepatic venous pressure gradient and its clinical application: A comparison study

Table 1 Baseline characteristics

Parameter	10 mmHg ≤ HVPG < 16 mmHg (n = 70)					HVPG ≥ 16 mmHg (n = 114)
	Total	Endoscopic therapy + NSBBs (n = 46)	Covered TIPS (n = 24)	P value	Total	Endoscopic therapy + NSBBs (n = 56)	Covered TIPS (n = 58)	P value
Mean age (yr)	55.27 ± 13.86	55.74 ± 13.44	54.38 ± 14.87	0.7	58.12 ± 11.22	57.30 ± 10.89	58.91 ± 11.57	0.45
Sex
Male/female	39/31	28/18	11/13	0.31	68/46	34/22	34/24	0.85
Previous bleeding history
0/1-2/> 3	41/26/3	31/15/0	10/11/3	0.02	77/26/11	41/10/5	36/16/6	0.41
Virus/alcoholic/immune/others	29/6/16/19	23/3/10/10	6/3/6/9	0.21	74/8/15/17	40/3/4/9	34/5/11/8	0.23
PLT (× 10^9/L)	69.80 ± 41.48	67.56 ± 34.80	74.00 ± 52.37	0.54	73.3 ± 52.60	67.71 ± 38.00	78.6 ± 63.32	0.27
ALT (U/L)	28.24 ± 20.56	30.10 ± 22.65	23.94 ± 14.22	0.28	29.97 ± 21.50	30.5 ± 21.56	29.47 ± 21.63	0.80
AST (U/L)	33.09 ± 19.42	34.87 ± 21.50	29.11 ± 13.27	0.27	36.26 ± 23.93	34.72 ± 17.89	37.75 ± 28.67	0.51
Tbil (μmol/L)	21.60 ± 13.80	21.76 ± 18.16	21.28 ± 12.20	0.94	20.69 ± 13.19	18.61 ± 11.60	22.6 9± 14.37	0.10
Creatinine (μmol/L)	64.79 ± 29.51	62.23 ± 18.36	70.91 ± 46.74	0.30	62.78 ± 17.31	62.89 ± 17.31	62.67 ± 17.48	0.95
Albumin (g/L)	35.05 ± 4.31	36.27 ± 3.89	32.71 ± 4.18	< 0.01	34.06 ± 5.11	34.98 ± 4.71	33.16 ± 5.37	0.06
Prothrombin time (s)	14.24 ± 2.33	14.05 ± 2.16	14.67 ± 2.69	0.35	14.89 ± 2.24	14.14 ± 1.84	15.59 ± 2.37	< 0.001
INR	1.24 ± 0.20	1.22 ± 0.19	1.27 ± 0.23	0.4	1.28 ± 0.19	1.23 ± 0.16	1.34 ± 0.21	< 0.001
Child–Pugh scores	6.26 ± 1.15	6.02 ± 1.13	6.71 ± 1.08	0.02	6.89 ± 1.37	6.46 ± 1.21	7.31 ± 1.40	< 0.001
Child–Pugh stage (A/B/C)	46/23/1	35/10/1	11/13/0	0.02	50/59/5	31/24/1	19/35/4	0.03
MELD score	16 ± 5.82	15 ± 5.83	17 ± 5.59	0.12	16 ± 4.95	16 ± 4.37	17 ± 5.44	0.27
Ascites (yes/no)	35/35	27/19	8/16	0.12	24/90	19/36	5/54	< 0.001
Shunt (yes/no)	10/60	6/40	4/20	0.73	9/105	6/50	3/55	0.27
Baseline HVPG (mmHg)	13.04 ± 1.75	12.88 ± 1.78	13.35 ± 1.69	0.30	21.17 ± 4.40	18.82 ± 2.45	23.44 ± 4.68	< 0.001
Baseline WHVP (mmHg)	21.32 ± 3.98	21.37 ± 3.96	21.23 ± 4.13	0.90	29.14 ± 5.24	26.79 ± 4.01	31.41 ± 5.31	< 0.001
Baseline FHVP (mmHg)	8.42 ± 3.11	8.71 ± 3.05	7.88 ± 3.24	0.30	7.98 ± 3.26	7.96 ± 3.07	8.01 ± 3.47	0.93
Baseline IVCP (mmHg)	7.58 ± 3.15	7.75 ± 3.10	7.25 ± 3.30	0.53	7.12 ± 3.18	7.20 ± 3.07	7.05 ± 3.30	0.81
Baseline RAP (mmHg)	6.24 ± 3.05	6.34 ± 3.05	6.06 ± 3.11	0.72	5.68 ± 3.10	5.70 ± 3.10	5.66 ± 3.12	0.94
Severity of varicosity
(Mild/Moderate/Severe)	11/23/36	7/13/26	4/10/10	0.46	17/30/67	11/13/32	6/17/35	0.35
EV/GOV1/GOV2 /or IGV (no/yes)	47/25/16/3	31/16/9/1	16/9/7/2	0.66	63/31/29/9	31/12/14/4	32/19/15/5	0.80
Numbers of endoscopic therapy (times)	-	2.21 ± 1.32	-	-	-	2.36 ± 1.19	-	-
Pre-TIPS PPG (mmHg)	-	-	28.69 ± 5.67	-	-	-	32.18 ± 5.90	-
post-TIPS PPG (mmHg)	-	-	18.79 ± 5.23	-	-	-	21.69 ± 5.99	-
Interventions required due to stent dysfunction	-	-	3	-	-	-	9	-
Registration time to research ending (mo)	65.14 ± 19.83	62.47 ± 15.82	70.29 ± 25.46	0.18	55.94 ± 19.90	52.91 ± 17.33	58.86 ± 21.86	0.11
Median follow-up time (mo)	56	56	58.5	-	49.5	45	51.5	-

HVPG: Hepatic venous pressure gradient; NSBBs: Non-selective β-blockers; TIPS: Transjugular intrahepatic portosystemic shunts; PLT: Platelets; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; Tbil: Total bilirubin; INR: International normalized ratio; MELD: The model for end-stage liver disease; WHVP: Wedged hepatic venous pressure; FHVP: Free hepatic venous pressure; IVCP: Inferior vena cava pressure; RAP: Right atrium pressure; EV: Esophageal varices; GOV: Gastroesophageal varices; IGV: Isolated gastric varices; PPG: Portal pressure gradient.

Table 2 Cox regression evaluation of factors associated with mortality

Univariate analysis		Multivariate analysis
Hazard ratio	P value	Hazard ratio	P value
1.03 (1.01, 1.06)	0.04	1.03 (1.01, 1.06)	0.02
1.01 (1.01, 1.02)	0.01	-	-
1.01 (1.00, 1.02)	0.03	1.03 (1.00, 1.06)	0.01
1.63 (0.92, 2.89)	0.09	2.01 (1.04, 3.89)	0.04
0.610 (0.35, 1.05)	0.07	0.447 (0.25, 0.81)	0.01

Table 3 Distribution of the causes of endpoint

		Uncontrolled rebleeding	OHE	MODS	Liver transplantation	Nonliver related death
HVPG ≥ 16 mmHg (n = 114)	Endoscopic therapy + NSBBs (n = 56)	10	6	3	3	0
	Covered TIPS (n = 58)	0	10	2	3	2
10 mmHg ≤ HVPG < 16 mmHg (n = 70)	Endoscopic therapy + NSBBs (n = 46)	5	0	1	2	2
	Covered TIPS (n = 24)	0	3	0	4	0

HVPG: Hepatic venous pressure gradient; NSBBs: Non-selective β-blockers; TIPS: Transjugular intrahepatic portosystemic shunts; OHE: Overt hepatic encephalopathy; MODS: Multiple organ dysfunction syndrome.

Table 4 Distribution of the causes of rebleeding

		EGVB	Ectopic variceal bleeding	Ulcer bleeding	Portal hypertensive gastropathy	Venous invasion of HCC	Hematobilia
HVPG ≥ 16 mmHg (n = 114)	Endoscopic therapy + NSBBs (n = 56)	24	0	3	1	1	0
	Covered TIPS (n = 58)	9	0	1	0	0	1
10 mmHg ≤ HVPG < 16 mmHg (n = 70)	Endoscopic therapy + NSBBs (n = 46)	16	1	3	1	0	1
	Covered TIPS (n = 24)	3	0	0	0	0	0

HVPG: Hepatic venous pressure gradient; NSBBs: Non-selective β-blockers; TIPS: Transjugular intrahepatic portosystemic shunts; EGVB: Esophageal and gastric varices bleeding; HCC: Hepatocellular carcinoma.

Table 5 Rates of complications in the endoscopic therapy+nonselective β-blockers and covered transjugular intrahepatic portosystemic shunt groups

Complications	10 mmHg ≤ HVPG < 16 mmHg (n = 70)				HVPG ≥ 16 mmHg (n = 114)
	Total	Endoscopic therapy + NSBBs (n = 46)	Covered TIPS (n = 24)	P value	Total	Endoscopic therapy + NSBBs (n = 56)	Covered TIPS (n = 58)	P value
OHE during follow-up (yes/no)	2/68	0/46	2/22	0.11	10/104	3/53	9/49	0.049
Jaundice during follow-up (yes/no)	22/48	14/32	8/16	0.79	46/68	17/39	29/29	0.04
Ascites during follow-up (yes/no)	29/41	18/28	11/13	0.62	75/39	38/18	37/21	0.70
Hypercreatinemia during follow-up(yes/no)	10/60	5/41	5/19	0.29	13/101	6/50	7/51	1.00
Hyponatremia during follow-up (yes/no)	11/59	9/37	2/22	0.31	8/106	4/52	4/54	1.00
OHE in 1 year (yes/no)	8/62	3/43	5/19	0.09	22/92	9/47	13/45	0.48
Jaundice in 1 year(yes/no)	11/59	5/41	6/18	0.17	29/85	8/48	21/37	0.01
Ascites in 1 year (yes/no)	34/36	23/23	11/13	0.80	74/40	35/21	39/19	0.70
Hypercreatinemia in 1 year (yes/no)	5/65	2/44	3/21	0.33	4/110	3/53	1/57	0.36
Hyponatremia in 1 year (yes/no)	7/63	5/41	2/22	1.00	20/94	12/44	8/50	0.33

HVPG: Hepatic venous pressure gradient; NSBBs: Non-selective β-blockers; TIPS: Transjugular intrahepatic portosystemic shunts; OHE: Overt hepatic encephalopathy.