Decompensation in Advanced Nonalcoholic Fatty Liver Disease May Occur at Lower Hepatic Venous Pressure Gradient Levels Than in Patients With Viral Disease
Por:
Bassegoda O., Olivas P., Turco L., Mandorfer M., Serra-Burriel M., Tellez L., Kwanten W., Laroyenne A., Farcau O., Alvarado E., Moga L., Vuille-Lessard E., Fortea J.I., Ibañez L., Tosetti G., Vanwolleghem T., Larrue H., Burgos-Santamaría D., Stefanescu H., Paternostro R., Cippitelli A., Lens S., Augustin S., Llop E., Laleman W., Trebicka J., Chang J., Masnou H., Zipprich A., Miceli F., Semmler G., Forns X., Primignani M., Bañares R., Puente A., Berzigotti A., Rautou P.E., Villanueva C., Ginès P., Garcia-Pagan J.C., Procopet B., Bureau C., Albillos A., Francque S., Reiberger T., Schepis F., Graupera I., Hernandez-Gea V.
Publicada:
1 oct 2022
Ahead of Print:
1 ene 2021
Resumen:
Background & Aims: Portal hypertension is the strongest predictor of hepatic decompensation and death in patients with cirrhosis. However, its discriminatory accuracy in patients with nonalcoholic fatty liver disease (NAFLD) has been challenged because hepatic vein catheterization may not reflect the real portal vein pressure as accurately as in patients with other etiologies. We aimed to evaluate the relationship between hepatic venous pressure gradient (HVPG) and presence of portal hypertension–related decompensation in patients with advanced NAFLD (aNAFLD). Methods: Multicenter cross-sectional study included 548 patients with aNAFLD and 444 with advanced RNA-positive hepatitis C (aHCV) who had detailed portal hypertension evaluation (HVPG measurement, gastroscopy, and abdominal imaging). We examined the relationship between etiology, HVPG, and decompensation by logistic regression models. We also compared the proportions of compensated/decompensated patients at different HVPG levels. Results: Both cohorts, aNAFLD and aHVC, had similar baseline age, gender, Child-Pugh score, and Model for End-Stage Liver Disease score. Median HVPG was lower in the aNAFLD cohort (13 vs 15 mmHg) despite similar liver function and higher rates of decompensation in aNAFLD group (32% vs 25%; P =.019) than in the aHCV group. For any of the HVPG cutoff analyzed (<10, 10–12, or 12 mmHg) the prevalence of decompensation was higher in the aNAFLD group than in the aHCV group. Conclusions: Patients with aNAFLD have higher prevalence of portal hypertension–related decompensation at any value of HVPG as compared with aHCV patients. Longitudinal studies aiming to identify HVPG thresholds able to predict decompensation and long-term outcomes in aNAFLD population are strongly needed. © 2021 AGA Institute
Filiaciones:
Bassegoda O.:
Liver Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
Olivas P.:
Liver Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
Barcelona Hepatic Hemodynamic Laboratory, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver), Barcelona, Spain
Turco L.:
Division of Gastroenterology, Azienda Ospedaliero-Universitaria di Modena and University of Modena and Reggio Emilia, Modena, Italy
Mandorfer M.:
Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of ViennaVienna, Austria
Serra-Burriel M.:
Epidemiology, Biostatistics, and Epidemiology Institute, University of Zurich, Zurich, Switzerland
Tellez L.:
Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain
Kwanten W.:
Department of Gastroenterology and Hepatology, Antwerp University Hospital, Laboratory of Experimental Medicine and Pediatrics (LEMP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
Laroyenne A.:
Department of Hepato-gastroenterology, Purpan Hospital, CHU Toulouse, Inserm U858, University of Toulouse, Université Paul Sabatier, Toulouse, France
Farcau O.:
Regional Institute of Gastroenterology and Hepatology “Octavian fodor”, Hepatology Department and “luliu Hatieganu” University of Medicine and Pharmacy, 3rd Medical Clinic, Cluj-Napoca, Romania
Alvarado E.:
Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
Servei de Patología Digestiva, Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat autònoma de Barcelona, Bellaterra, Barcelona, Spain
Moga L.:
Service d'Hépatologie, DMU Digest, hôpital Beaujon, AP-HP, Clichy, France
Vuille-Lessard E.:
Hepatology, Inselspital, University Clinic of Visceral Surgery and Medicine (UVCM), University of Bern, Bern, Switzerland
Fortea J.I.:
Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
Gastroenterology and Hepatology Department, University Hospital Marqués de Valdecilla, Health Research Institute Marqués de Valdecilla (IDIVAL), Santander, Spain
Ibañez L.:
Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
Servicio de Gastroenterología y hepatología, Hospital Gregorio Marañón, Madrid, España, Spain
Tosetti G.:
Division of Gastroenterology and Hepatology, Fundation IRCCS Ca´Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
Vanwolleghem T.:
Department of Gastroenterology and Hepatology, Antwerp University Hospital, Laboratory of Experimental Medicine and Pediatrics (LEMP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
Larrue H.:
Department of Hepato-gastroenterology, Purpan Hospital, CHU Toulouse, Inserm U858, University of Toulouse, Université Paul Sabatier, Toulouse, France
Burgos-Santamaría D.:
Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain
Stefanescu H.:
Regional Institute of Gastroenterology and Hepatology “Octavian fodor”, Hepatology Department and “luliu Hatieganu” University of Medicine and Pharmacy, 3rd Medical Clinic, Cluj-Napoca, Romania
Paternostro R.:
Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of ViennaVienna, Austria
Cippitelli A.:
Division of Gastroenterology, Azienda Ospedaliero-Universitaria di Modena and University of Modena and Reggio Emilia, Modena, Italy
Lens S.:
Liver Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
Augustin S.:
Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Institut de Recerca, Vall d'Hebron, Barcelona, Spain
Llop E.:
Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
Liver Unit, Hospital U, Puerta de Hierro, Universidad Autònoma de Madrid, CIBERehd, Madrid, Spain
Laleman W.:
Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
Trebicka J.:
Translational Hepatology, Department of Internal Medicine I, Goethe University Clinic, Frankfurt, Germany
Chang J.:
Department of Internal Medicine I, University of Bonn, Bonn, Germany
Masnou H.:
Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
Hospital Universitari Germans Trias I Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
Zipprich A.:
First Department of Internal Medicine, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
Miceli F.:
Division of Gastroenterology, Azienda Ospedaliero-Universitaria di Modena and University of Modena and Reggio Emilia, Modena, Italy
Semmler G.:
Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of ViennaVienna, Austria
Forns X.:
Liver Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
Primignani M.:
Division of Gastroenterology and Hepatology, Fundation IRCCS Ca´Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
Bañares R.:
Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
Servicio de Gastroenterología y hepatología, Hospital Gregorio Marañón, Madrid, España, Spain
Puente A.:
Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
Gastroenterology and Hepatology Department, University Hospital Marqués de Valdecilla, Health Research Institute Marqués de Valdecilla (IDIVAL), Santander, Spain
Berzigotti A.:
Hepatology, Inselspital, University Clinic of Visceral Surgery and Medicine (UVCM), University of Bern, Bern, Switzerland
Rautou P.E.:
Service d'Hépatologie, DMU Digest, hôpital Beaujon, AP-HP, Clichy, France
Villanueva C.:
Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
Servei de Patología Digestiva, Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat autònoma de Barcelona, Bellaterra, Barcelona, Spain
Ginès P.:
Liver Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
Garcia-Pagan J.C.:
Liver Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
Barcelona Hepatic Hemodynamic Laboratory, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver), Barcelona, Spain
Procopet B.:
Regional Institute of Gastroenterology and Hepatology “Octavian fodor”, Hepatology Department and “luliu Hatieganu” University of Medicine and Pharmacy, 3rd Medical Clinic, Cluj-Napoca, Romania
Bureau C.:
Department of Hepato-gastroenterology, Purpan Hospital, CHU Toulouse, Inserm U858, University of Toulouse, Université Paul Sabatier, Toulouse, France
Albillos A.:
Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain
Francque S.:
Department of Gastroenterology and Hepatology, Antwerp University Hospital, Laboratory of Experimental Medicine and Pediatrics (LEMP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
Reiberger T.:
Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of ViennaVienna, Austria
Schepis F.:
Division of Gastroenterology, Azienda Ospedaliero-Universitaria di Modena and University of Modena and Reggio Emilia, Modena, Italy
Graupera I.:
Liver Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
Hernandez-Gea V.:
Liver Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
Barcelona Hepatic Hemodynamic Laboratory, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver), Barcelona, Spain
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