Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Apr 8, 2015; 7(4): 688-695
Published online Apr 8, 2015. doi: 10.4254/wjh.v7.i4.688
Cirrhosis and portal hypertension: The importance of risk stratification, the role of hepatic venous pressure gradient measurement
Vincenzo La Mura, Antonio Nicolini, Giulia Tosetti, Massimo Primignani
Vincenzo La Mura, Antonio Nicolini, Giulia Tosetti, Massimo Primignani, Fondazione IRCCS, Ca’ Granda, Ospedale Maggiore Policlinico, 20100 Milano, Italy
Author contributions: La Mura V contributed to review concept and design; La Mura V and Tosetti G contributed to drafting of the manuscript; Nicolini A and Primignani M contributed to critical revision of the manuscript for important intellectual content.
Conflict-of-interest: There are no conflict of interest to declare related with the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Vincenzo La Mura, MD, PhD, Fondazione IRCCS, Ca’ Granda, Ospedale Maggiore Policlinico, via F. Sforza, 20100 Milano, Italy.
Telephone: +39-02-5035432 Fax: +39-02-50320410
Received: August 29, 2014
Peer-review started: August 29, 2014
First decision: October 14, 2014
Revised: November 11, 2014
Accepted: January 9, 2015
Article in press: January 12, 2015
Published online: April 8, 2015

Portal hypertension is the main prognostic factor in cirrhosis. The recent emergence of potent antiviral drugs and new algorithm of treatment for the management of complications due to portal hypertension have sensibly changed our perception of cirrhosis that can be now considered as a multistage liver disease whose mortality risk can be reduced by a tailored approach for any stage of risk. Experts recommend to move toward a pathophysiological classification of cirrhosis that considers both structural and functional changes. The hepatic venous pressure gradient HVPG, is the reference gold standard to estimate the severity of portal hypertension in cirrhosis. It correlates with both structural and functional changes that occur in cirrhosis and carries valuable prognostic information to stratify the mortality risk. This article provides a general overview of the pathophysiology and natural course of cirrhosis and portal hypertension. We propose a simplified classification of cirrhosis based on low, intermediate and high mortality stage. The prognostic information provided by HVPG is presented according to each stage. A comparison with prognostic models based on clinical and endoscopic variables is discussed in order to evidence the additional contribute given by HVPG on top of other clinical and instrumental variables widely used in clinical practice.

Keywords: Cirrhosis, Portal hypertension, Hepatic venous pressure gradient, Variceal bleeding, Prognosis

Core tip: Recently a pathophysiological classification of cirrhosis has been strongly encouraged. Hepatic venous pressure gradient (HVPG) measurement is the most reliable tool to estimate the severity of portal hypertension in cirrhosis but several methodological concerns have limited its use in clinical practice. The article summarizes the results published about the prognostic value of HVPG and originally offers a critical revision of the information provided by this hemodynamic parameter on top of the most widely used models based on non-hemodynamic parameters.