Early portopulmonary hypertension predicts mortality in patients with cirrhosis: Insights from the PORTO-DETECT cohort
Por:
Téllez, L, Donate, J, Guerrero, A, Beraza, IA, San Martín, D, Alvarado, E, Echevarria, V, Puente, A, Zamora, J, Del Prado, S, Tenes, A, Balagué, G, Vidal, B, Geli, C, Rodriguez-Gandia, MA, Baiges, A, Brujats, A, Rodríguez, DLH, Sánchez, SFG, Fortea, JI, del Cerro, MJ, Villanueva, C, Garcia-Pagán, JC, Giráldez, A, Albillos, A
Publicada:
1 feb 2026
Ahead of Print:
1 ene 2026
Resumen:
Background & Aims: Portopulmonary hypertension (PoPH) is a severe complication of cirrhosis and portal hypertension. In 2022, a European task force revised the diagnostic criteria for pulmonary arterial hypertension (PAH), defining early stages as a mean pulmonary arterial pressure (mPAP) of 20.5-24.5 mmHg and pulmonary vascular resistance (PVR) >2 Wood units. We evaluated the prognostic value of these revised criteria in patients with cirrhosis. Methods: In this longitudinal, multicenter, observational cohort, 428 adults with cirrhosis and portal hypertension underwent right-heart catheterization between 2015 and 2023 and were stratified into five groups: normal, early PoPH, classic PoPH, post-capillary pulmonary hypertension, and unclassified profiles. All-cause mortality was analyzed by multivariable Cox regression and competing-risk models, with liver transplantation as an intercurrent event. Results: Over a median follow-up time of 20.0 months (IQR 8.0-36.0), 3-year survival rates were 76.7%, 49.5%, and 42.0% in the normal mPAP, early PoPH, and classic PoPH groups, respectively. After adjustment for age, sex, liver function, and portal hypertension severity, both early PoPH (hazard ratio 3.5; 95% CI 1.9-6.3; p <0.01) and classic PoPH (hazard ratio 4.5; 2.6-7.6; p <0.01) remained independent predictors of mortality vs. normal mPAP; these associations persisted in competing-risk analysis, whereas post-capillary pulmonary hypertension and unclassified groups did not differ from the normal mPAP cohort. Conclusion: Applying the 2022 ESC/ERC definitions of PAH identifies a subset of patients with cirrhosis with early-stage PoPH, characterized by mild pulmonary vascular resistance elevation, who nevertheless face a markedly increased risk of death, emphasizing the need for systematic screening and early targeted intervention. (c) 2025 European Association for the Study of the Liver. Published by Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
Filiaciones:
Téllez, L:
Univ Alcala, Hosp Univ Ramon Y Cajal, Gastroenterol & Hepatol Dept, IRYCIS,CIBERehd, Ctra Colmenar Viejo,Km 9 100, Madrid 28034, Spain
Donate, J:
Univ Alcala, Hosp Univ Ramon Y Cajal, Gastroenterol & Hepatol Dept, IRYCIS,CIBERehd, Ctra Colmenar Viejo,Km 9 100, Madrid 28034, Spain
Guerrero, A:
Univ Alcala, Hosp Univ Ramon Y Cajal, Gastroenterol & Hepatol Dept, IRYCIS,CIBERehd, Ctra Colmenar Viejo,Km 9 100, Madrid 28034, Spain
Beraza, IA:
Univ Seville, Hosp Univ Virgen Rocio, Digest Dis Dept, Inst Biomed,HUVR,CSIC,US, Seville, Spain
San Martín, D:
Inst Invest Biomed August Pi I Sunyer IDIBAPS, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona Hepat Hemodynam Lab, Liver Unit,Hosp Clin, Barcelona, Spain
Univ Barcelona, Dept Med & Ciencies Salut, European Reference Network Rare Liver Disorders ER, Barcelona, Spain
Alvarado, E:
Hosp Santa Creu & Sant Pau, Dept Gastroenterol, Barcelona, Spain
Autonomous Univ Barcelona UAB, Biomed Res Inst St Pau IIB St Pau, Dept Med, Barcelona, Spain
Inst Salud Carlos III, Digest Dis Network CIBERehd, Ctr Biomed Res Liver, Madrid, Spain
Echevarria, V:
Marques Valdecilla Univ Hosp, Valdecilla Res Inst IDIVAL, Gastroenterol & Hepatol Dept, Clin & Translat Res Digest Dis, Santander, Spain
Puente, A:
Marques Valdecilla Univ Hosp, Valdecilla Res Inst IDIVAL, Gastroenterol & Hepatol Dept, Clin & Translat Res Digest Dis, Santander, Spain
Zamora, J:
Hosp Univ Ramon y Cajal IRYCIS, Clin Biostat Unit, Madrid, Spain
CIBER Epidemiol & Publ Hlth CIBERES, Madrid, Spain
Univ Birmingham, WHO Collaborating Ctr Global Womenns Hlth, Inst Metab & Syst Res, Birmingham, England
Tenes, A:
Univ Alcala, Hosp Univ Ramon Y Cajal, Resp Dis Dept, IRYCIS, Madrid, Spain
Balagué, G:
Univ Barcelona, Hosp Clin, Cardiovasc Inst, Dept Cardiol, Barcelona, Spain
Vidal, B:
Univ Barcelona, Hosp Clin, Cardiovasc Inst, Dept Cardiol, Barcelona, Spain
Geli, C:
Hosp Santa Creu & Sant Pau, Dept Gastroenterol, Barcelona, Spain
Autonomous Univ Barcelona UAB, Biomed Res Inst St Pau IIB St Pau, Dept Med, Barcelona, Spain
Inst Salud Carlos III, Digest Dis Network CIBERehd, Ctr Biomed Res Liver, Madrid, Spain
Rodriguez-Gandia, MA:
Univ Alcala, Hosp Univ Ramon Y Cajal, Gastroenterol & Hepatol Dept, IRYCIS,CIBERehd, Ctra Colmenar Viejo,Km 9 100, Madrid 28034, Spain
Baiges, A:
Inst Invest Biomed August Pi I Sunyer IDIBAPS, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona Hepat Hemodynam Lab, Liver Unit,Hosp Clin, Barcelona, Spain
Univ Barcelona, Dept Med & Ciencies Salut, European Reference Network Rare Liver Disorders ER, Barcelona, Spain
Brujats, A:
Inst Invest Biomed August Pi I Sunyer IDIBAPS, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona Hepat Hemodynam Lab, Liver Unit,Hosp Clin, Barcelona, Spain
Univ Barcelona, Dept Med & Ciencies Salut, European Reference Network Rare Liver Disorders ER, Barcelona, Spain
Rodríguez, DLH:
Hosp Univ Virgen Rocio, Anesthesiol Dept, Seville, Spain
Sánchez, SFG:
Hosp Univ Virgen Rocio, Cardiol Dept, Seville, Spain
Fortea, JI:
Marques Valdecilla Univ Hosp, Valdecilla Res Inst IDIVAL, Gastroenterol & Hepatol Dept, Clin & Translat Res Digest Dis, Santander, Spain
del Cerro, MJ:
Univ Alcala, Pediat Cardiol & Cardiac Congenital Dis Dept, IRYCIS, Madrid, Spain
Villanueva, C:
Inst Invest Biomed August Pi I Sunyer IDIBAPS, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona Hepat Hemodynam Lab, Liver Unit,Hosp Clin, Barcelona, Spain
Univ Barcelona, Dept Med & Ciencies Salut, European Reference Network Rare Liver Disorders ER, Barcelona, Spain
Garcia-Pagán, JC:
Inst Invest Biomed August Pi I Sunyer IDIBAPS, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona Hepat Hemodynam Lab, Liver Unit,Hosp Clin, Barcelona, Spain
Univ Barcelona, Dept Med & Ciencies Salut, European Reference Network Rare Liver Disorders ER, Barcelona, Spain
Giráldez, A:
Univ Seville, Hosp Univ Virgen Rocio, Digest Dis Dept, Inst Biomed,HUVR,CSIC,US, Seville, Spain
Albillos, A:
Univ Alcala, Hosp Univ Ramon Y Cajal, Gastroenterol & Hepatol Dept, IRYCIS,CIBERehd, Ctra Colmenar Viejo,Km 9 100, Madrid 28034, Spain
Hosp Univ Ramon Y Cajal, Univ Alcala, Cardiol Dept, IRYCIS,CIBERCV, Madrid, Spain
Green Accepted
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