Hepatic venous pressure gradient predicts risk of hepatic decompensation and liver-related mortality in patients with MASLD
Por:
Paternostro, R, Kwanten, WJ, Hofer, BS, Semmler, G, Bagdadi, A, Luzko, I, Hernández-Gea, V, Graupera, I, García-Pagán, JC, Saltini, D, Indulti, F, Schepis, F, Moga, L, Rautou, PE, Llop, E, Téllez, L, Albillos, A, Fortea, JI, Puente, A, Tosetti, G, Primignani, M, Zipprich, A, Vuille-Lessard, E, Berzigotti, A, Taru, MG, Taru, V, Procopet, B, Jansen, C, Praktiknjo, M, Gu, WY, Trebicka, J, Ibanez-Samaniego, L, Bañares, R, Rivera-Esteban, J, Pericas, JM, Genesca, J, Alvarado, E, Villanueva, C, Larrue, H, Bureau, C, Laleman, W, Ardevol, A, Masnou, H, Vanwolleghem, T, Trauner, M, Mandorfer, M, Francque, S, Reiberger, T
Publicada:
1 nov 2024
Ahead of Print:
1 oct 2024
Resumen:
Background & Aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a leading cause of advanced chronic liver disease (ACLD). Portal hypertension drives hepatic decompensation and is best diagnosed by hepatic venous pressure gradient (HVPG) measurement. Here, we investigate the prognostic value of HVPG in MASLD-related compensated ACLD (MASLD-cACLD). Methods: This European multicentre study included patients with MASLD-cACLD characterised by HVPG at baseline. Hepatic decompensation (variceal bleeding/ascites/hepatic encephalopathy) and liver-related mortality were considered the primary events of interest. Results: A total of 340 patients with MASLD-cACLD (56.2% male; median age 62 [55-68] years, median MELD 8 [7-9], 71.2% with diabetes) were included. Clinically significant portal hypertension (CSPH: i.e., HVPG >= 10 mmHg) was found in 209 patients (61.5%). During a median follow-up of 41.5 (27.5-65.8) months, 65 patients developed hepatic decompensation with a cumulative incidence of 10.0% after 2 years (2Y) and 30.7% after 5 years (5Y) in those with MASLD-cACLD with CSPH, compared to 2.4% after 2Y and 9.4% after 5Y in patients without CSPH. Variceal bleeding did not occur without CSPH. CSPH (subdistribution hazard ratio [SHR] 5.13; p <0.001) was associated with an increased decompensation risk and a higher HVPG remained an independent risk factor in the multivariable model (adjusted SHR per mmHg: 1.12, p <0.001). Liver-related mortality occurred in 37 patients at a cumulative incidence of 3.3% after 2Y and 21.4% after 5Y in CSPH. Without CSPH, the incidence after 5Y was 0.8%. Accordingly, a higher HVPG was also independently associated with a higher risk of liver-related death (adjusted SHR per mmHg: 1.20, p <0.001). Conclusion: HVPG measurement is of high prognostic value in MASLD-cACLD. In patients with MASLD-cACLD without CSPH, the short-term risk of decompensation is very low and liver-related mortality is rare, while the presence of CSPH substantially increases the risk of both. (c) 2024 The Authors. Published by Elsevier B.V. on behalf of European Association for the Study of the Liver. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Filiaciones:
Paternostro, R:
Med Univ Vienna, Dept Med 3, Div Gastroenterol & Hepatol, Waehringer Guertel 18-20, A-1090 Vienna, Austria
Kwanten, WJ:
Antwerp Univ Hosp, Dept Gastroenterol Hepatol, Edegem, Belgium
Univ Antwerp, Fac Med & Hlth Sci, Div Gastroenterol Hepatol, Lab Expt Med & Pediat LEMP, Antwerp, Belgium
Hofer, BS:
Med Univ Vienna, Dept Med 3, Div Gastroenterol & Hepatol, Waehringer Guertel 18-20, A-1090 Vienna, Austria
Semmler, G:
Med Univ Vienna, Dept Med 3, Div Gastroenterol & Hepatol, Waehringer Guertel 18-20, A-1090 Vienna, Austria
Bagdadi, A:
Antwerp Univ Hosp, Dept Gastroenterol Hepatol, Edegem, Belgium
Luzko, I:
Univ Barcelona, Hosp Clin, Liver Unit, IDIBAPS, Barcelona, Spain
Hernández-Gea, V:
Univ Barcelona, Hosp Clin, Liver Unit, IDIBAPS, Barcelona, Spain
Graupera, I:
Univ Barcelona, Hosp Clin, Liver Unit, IDIBAPS, Barcelona, Spain
García-Pagán, JC:
Univ Barcelona, Hosp Clin, Liver Unit, IDIBAPS, Barcelona, Spain
Saltini, D:
Azienda Osped Univ Modena, Div Gastroenterol, Modena, Italy
Univ Modena & Reggio Emilia, Modena, Italy
Indulti, F:
Azienda Osped Univ Modena, Div Gastroenterol, Modena, Italy
Univ Modena & Reggio Emilia, Modena, Italy
Schepis, F:
Azienda Osped Univ Modena, Div Gastroenterol, Modena, Italy
Univ Modena & Reggio Emilia, Modena, Italy
Moga, L:
Hop Beaujon, AP HP, Ctr Reference Malad Vasc Foie, Serv dHepatol,DMU DIGEST,FILFOIE, Clichy, France
Rautou, PE:
Hop Beaujon, AP HP, Ctr Reference Malad Vasc Foie, Serv dHepatol,DMU DIGEST,FILFOIE, Clichy, France
Llop, E:
Puerta de Hierro Univ Autonoma Madrid, Hosp U, Liver Unit, CIBERehd, Madrid, Spain
Univ Alcala, Hosp Univ Ramon y Cajal, Dept Gastroenterol, Inst Ramon y Cajal Invest Sanitaria IRYCIS, Madrid, Spain
Univ Paul Sabatier Touluse, Univ Toulouse, Dept Hepatogastroenterol, Purpan Hosp,CHU Toulouse,InSERM U858, F-31062 Touluse, France
Téllez, L:
Univ Alcala, Hosp Univ Ramon y Cajal, Dept Gastroenterol, Inst Ramon y Cajal Invest Sanitaria IRYCIS, Madrid, Spain
Univ Paul Sabatier Touluse, Univ Toulouse, Dept Hepatogastroenterol, Purpan Hosp,CHU Toulouse,InSERM U858, F-31062 Touluse, France
Albillos, A:
Univ Alcala, Hosp Univ Ramon y Cajal, Dept Gastroenterol, Inst Ramon y Cajal Invest Sanitaria IRYCIS, Madrid, Spain
Univ Paul Sabatier Touluse, Univ Toulouse, Dept Hepatogastroenterol, Purpan Hosp,CHU Toulouse,InSERM U858, F-31062 Touluse, France
Fortea, JI:
Univ Alcala, Hosp Univ Ramon y Cajal, Dept Gastroenterol, Inst Ramon y Cajal Invest Sanitaria IRYCIS, Madrid, Spain
Univ Hosp Marques Valdecilla, Hlth Res Inst Marques Valdecilla IDIVAL, Gastroenterol & Hepatol Dept, Santander, Spain
Univ Paul Sabatier Touluse, Univ Toulouse, Dept Hepatogastroenterol, Purpan Hosp,CHU Toulouse,InSERM U858, F-31062 Touluse, France
Puente, A:
Univ Alcala, Hosp Univ Ramon y Cajal, Dept Gastroenterol, Inst Ramon y Cajal Invest Sanitaria IRYCIS, Madrid, Spain
Univ Hosp Marques Valdecilla, Hlth Res Inst Marques Valdecilla IDIVAL, Gastroenterol & Hepatol Dept, Santander, Spain
Univ Paul Sabatier Touluse, Univ Toulouse, Dept Hepatogastroenterol, Purpan Hosp,CHU Toulouse,InSERM U858, F-31062 Touluse, France
Tosetti, G:
Univ Alcala, Hosp Univ Ramon y Cajal, Dept Gastroenterol, Inst Ramon y Cajal Invest Sanitaria IRYCIS, Madrid, Spain
Univ Milan, Fundat IRCCS Ca Granda Osped Maggiore Policlin, Div Gastroenterol & Hepatol, Milan, Italy
Univ Paul Sabatier Touluse, Univ Toulouse, Dept Hepatogastroenterol, Purpan Hosp,CHU Toulouse,InSERM U858, F-31062 Touluse, France
Primignani, M:
Univ Alcala, Hosp Univ Ramon y Cajal, Dept Gastroenterol, Inst Ramon y Cajal Invest Sanitaria IRYCIS, Madrid, Spain
Univ Milan, Fundat IRCCS Ca Granda Osped Maggiore Policlin, Div Gastroenterol & Hepatol, Milan, Italy
Univ Paul Sabatier Touluse, Univ Toulouse, Dept Hepatogastroenterol, Purpan Hosp,CHU Toulouse,InSERM U858, F-31062 Touluse, France
Zipprich, A:
Martin Luther Univ Halle Wittenberg, Dept Internal Med 1, Halle An Der Saale, Germany
Friedrich Schiller Univ Jena, Jena Univ Hosp, Dept Internal Med 4, Jena, Germany
Vuille-Lessard, E:
Univ Bern, Univ Clin Visceral Surg & Med UVCM, Hepatol, Inselspital, Bern, Switzerland
Berzigotti, A:
Univ Bern, Univ Clin Visceral Surg & Med UVCM, Hepatol, Inselspital, Bern, Switzerland
Taru, MG:
Reg Inst Gastroenterol & Hepatol Octavian Fodor, Hepatol Dept, Cluj Napoca, Romania
luliu Hatieganu Univ Med, Pharm Med Clin 3, Cluj Napoca, Romania
Taru, V:
Reg Inst Gastroenterol & Hepatol Octavian Fodor, Hepatol Dept, Cluj Napoca, Romania
luliu Hatieganu Univ Med, Pharm Med Clin 3, Cluj Napoca, Romania
Procopet, B:
Reg Inst Gastroenterol & Hepatol Octavian Fodor, Hepatol Dept, Cluj Napoca, Romania
luliu Hatieganu Univ Med, Pharm Med Clin 3, Cluj Napoca, Romania
Jansen, C:
Univ Hosp Bonn, Dept Internal Med 1, Venusberg Campus 1, D-53127 Bonn, Germany
Praktiknjo, M:
Univ Hosp Munster, Dept Internal Med B, Munster, Germany
Gu, WY:
Univ Hosp Munster, Dept Internal Med B, Munster, Germany
Trebicka, J:
Univ Hosp Munster, Dept Internal Med B, Munster, Germany
Ibanez-Samaniego, L:
Univ Complutense, Hosp Gen Univ Gregorio Maranon, Serv Med Aparato Digest, Fac Med,IiSGM,CIBERehd, Madrid, Spain
Bañares, R:
Univ Complutense, Hosp Gen Univ Gregorio Maranon, Serv Med Aparato Digest, Fac Med,IiSGM,CIBERehd, Madrid, Spain
Rivera-Esteban, J:
Autonomous Univ Barcelona, Vall dHebron Univ Hosp, Vall dHebron Inst Res VHIR, CIBEREHD,Liver Unit, Vall dHebron Barcelona Hosp Campus, Madrid, Barcelona, Spain
Genesca, J:
Autonomous Univ Barcelona, Vall dHebron Univ Hosp, Vall dHebron Inst Res VHIR, CIBEREHD,Liver Unit, Vall dHebron Barcelona Hosp Campus, Madrid, Barcelona, Spain
Alvarado, E:
Univ autonoma Barcelona, Hosp St Creu i St Pau, Serv Patol Digest, Barcelona, Spain
Villanueva, C:
Univ autonoma Barcelona, Hosp St Creu i St Pau, Serv Patol Digest, Barcelona, Spain
Larrue, H:
Univ Paul Sabatier Touluse, Univ Toulouse, Dept Hepatogastroenterol, Purpan Hosp,CHU Toulouse,InSERM U858, F-31062 Touluse, France
Bureau, C:
Univ Paul Sabatier Touluse, Univ Toulouse, Dept Hepatogastroenterol, Purpan Hosp,CHU Toulouse,InSERM U858, F-31062 Touluse, France
Laleman, W:
Univ Hosp Leuven, Dept Gastroenterol & Hepatol, Leuven, Belgium
Ardevol, A:
Univ Autonoma Barcelona, Hosp Univ Germans Trias I Pujol, Badalona, Spain
Masnou, H:
Univ Autonoma Barcelona, Hosp Univ Germans Trias I Pujol, Badalona, Spain
Vanwolleghem, T:
Antwerp Univ Hosp, Dept Gastroenterol Hepatol, Edegem, Belgium
Univ Antwerp, Fac Med & Hlth Sci, Div Gastroenterol Hepatol, Lab Expt Med & Pediat LEMP, Antwerp, Belgium
Trauner, M:
Med Univ Vienna, Dept Med 3, Div Gastroenterol & Hepatol, Waehringer Guertel 18-20, A-1090 Vienna, Austria
Mandorfer, M:
Med Univ Vienna, Dept Med 3, Div Gastroenterol & Hepatol, Waehringer Guertel 18-20, A-1090 Vienna, Austria
Francque, S:
Univ Antwerp, Fac Med & Hlth Sci, Div Gastroenterol Hepatol, Lab Expt Med & Pediat LEMP, Antwerp, Belgium
Reiberger, T:
Med Univ Vienna, Dept Med 3, Div Gastroenterol & Hepatol, Waehringer Guertel 18-20, A-1090 Vienna, Austria
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