Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Nov 27, 2023; 15(11): 2490-2499
Published online Nov 27, 2023. doi: 10.4240/wjgs.v15.i11.2490
Hepatic venous pressure gradient: Inaccurately estimates portal venous pressure gradient in alcoholic cirrhosis and portal hypertension
Dan Zhang, Tao Wang, Zhen-Dong Yue, Lei Wang, Zhen-Hua Fan, Yi-Fan Wu, Fu-Quan Liu
Dan Zhang, Zhen-Dong Yue, Lei Wang, Zhen-Hua Fan, Yi-Fan Wu, Fu-Quan Liu, Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
Tao Wang, Department of Interventional Therapy, Yantai Yuhuangding Hospital of Qingdao University, Yantai 264099, Shandong Province, China
Author contributions: Liu FQ designed the research; Wang T, Yue ZD, Wang L, Fan ZH and Wu YF performed the research; Zhang D analyzed the data and wrote the paper; Liu FQ reviewed and revised the manuscript; All authors have read and approved the final manuscript.
Supported by the Capital Health Research and Development of Special, No. 2018-1-2081; National Natural Science Foundation of China, No. 81871461.
Institutional review board statement: The study was reviewed and approved by the Beijing Shijitan Hospital, Capital Medical University Institutional Review Board [2018(01)].
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at liufuquan@ccmu.edu.cn. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fu-Quan Liu, MM, Chief Doctor, Doctor, Professor, Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, No.10 Tieyi Road, Yangfangdian Street, Haidian District, Beijing 100038, China. liufuquan@ccmu.edu.cn
Received: August 13, 2023
Peer-review started: August 13, 2023
First decision: September 20, 2023
Revised: October 3, 2023
Accepted: October 23, 2023
Article in press: October 23, 2023
Published online: November 27, 2023
Processing time: 105 Days and 20.3 Hours
Abstract
BACKGROUND

Portal hypertension (PHT) in patients with alcoholic cirrhosis causes a range of clinical symptoms, including gastroesophageal varices and ascites. The hepatic venous pressure gradient (HVPG), which is easier to measure, has replaced the portal venous pressure gradient (PPG) as the gold standard for diagnosing PHT in clinical practice. Therefore, attention should be paid to the correlation between HVPG and PPG.

AIM

To explore the correlation between HVPG and PPG in patients with alcoholic cirrhosis and PHT.

METHODS

Between January 2017 and June 2020, 134 patients with alcoholic cirrhosis and PHT who met the inclusion criteria underwent various pressure measurements during transjugular intrahepatic portosystemic shunt procedures. Correlations were assessed using Pearson’s correlation coefficient to estimate the correlation coefficient (r) and determination coefficient (R2). Bland-Altman plots were constructed to further analyze the agreement between the measurements. Disagreements were analyzed using paired t tests, and P values < 0.05 were considered statistically significant.

RESULTS

In this study, the correlation coefficient (r) and determination coefficient (R2) between HVPG and PPG were 0.201 and 0.040, respectively (P = 0.020). In the 108 patients with no collateral branch, the average wedged hepatic venous pressure was lower than the average portal venous pressure (30.65 ± 8.17 vs. 33.25 ± 6.60 mmHg, P = 0.002). Hepatic collaterals were identified in 26 cases with balloon occlusion hepatic venography (19.4%), while the average PPG was significantly higher than the average HVPG (25.94 ± 7.42 mmHg vs 9.86 ± 7.44 mmHg; P < 0.001). The differences between HVPG and PPG < 5 mmHg in the collateral vs no collateral branch groups were three cases (11.54%) and 44 cases (40.74%), respectively.

CONCLUSION

In most patients, HVPG cannot accurately represent PPG. The formation of hepatic collaterals is a vital reason for the strong underestimation of HVPG.

Keywords: Portal hypertension; Portal venous pressure gradient; Hepatic venous pressure gradient; Alcoholic cirrhosis; Hepatic collateral

Core Tip: Portal hypertension (PHT) in alcoholic cirrhosis causes a range of clinical symptoms, including gastroesophageal varices and ascites. Because it is easier to measure, the hepatic venous pressure gradient (HVPG) has replaced the portal venous pressure gradient (PPG) as the gold standard for diagnosing PHT in clinical practice. However, our study showed a poor correlation between HVPG and PPG in patients with PHT and alcoholic cirrhosis. The underestimation of HVPG may be related to the formation of hepatic collaterals.