Prognostic value of early measurements of portal pressure in acute variceal bleeding
Prognostic value of early measurements of portal pressure in acute variceal bleeding
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DOI：
10.1016/s0016-5085(99)70455-5
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发表时间：
1999-09-01
期刊：
影响因子：
29.4
通讯作者：
Bosch, J
中科院分区：
文献类型：
--
作者：
Moitinho, E;Escorsell, N;Bosch, J
背景与目的：静脉曲张出血是门静脉高压症最重要的并发症。然而，门静脉压力升高与静脉曲张出血结局之间的关系尚未明确。研究方法：我们测量了65例急性静脉曲张出血患者的肝静脉压力梯度（HVPG），在入院后早期（20.6 ± 15.6小时）。结果23例患者进展较差（未能控制出血或早期静脉曲张再出血），42例进展顺利。与结局相关的唯一变量是HVPG，进展不良的患者其HVPG较高（23.7 +/- 6.1 vs. 19.2 +/- 3.3 mm Hg; P < 0.0004）。多变量分析证实了这一点。23例进展不良患者中有19例HVPG ≥ 20 mmHg，42例进展顺利患者中有12例HVPG ≥ 20 mmHg（P < 0.0001）;初始HVPG大于或等于20 mm Hg与重症监护室住院时间显著延长相关（7 +/- 5 vs. 4 +/- 2天; P < 0.02），住院时间更长（19 +/- 10 vs. 14 +/- 6天; P < 0.02），更大的输血需求（9.0 +/- 7.7 vs. 4.7 +/- 3.2 UU; P < 0.007），以及更差的精算生存概率（1年死亡率，64% vs. 20%; P < 0.002）。结论：在急性静脉曲张出血期间早期测量HVPG可为出血事件的演变和长期生存提供有用的预后信息。
Background & Aims: Variceal bleeding is the most important complication of portal hypertension. However, the relationship between the increase in portal pressure and the outcome of variceal bleeding has not been well defined. Methods: We measured the hepatic venous pressure gradient (HVPG) of 65 cirrhotic patients with acute variceal hemorrhage, early after admission (20.6 +/- 15.6 hours). Results. Twenty-three patients had a poor evolution (failure to control bleeding or early variceal rebleeding), and 42 had an uneventful evolution. The only variable associated with outcome was the HVPG, which was higher In patients with a poor evolution (23.7 +/- 6.1 vs. 19.2 +/- 3.3 mm Hg; P < 0.0004). This was confirmed by multivariate analysis. HVPG was greater than or equal to 20 mmHg in 19 of 23 patients with poor evolution vs, 12 of 42 patients with uneventful evolution (P < 0.0001); An initial HVPG of greater than or equal to 20 mm Hg was associated with a significantly longer intensive care unit stay (7 +/- 5 vs. 4 +/- 2 days; P < 0.02), longer hospital stay (19 +/- 10 vs. 14 +/- 6 days; P < 0.02), greater transfusion requirements (9.0 +/- 7.7 vs. 4.7 +/- 3.2 UU; P < 0.007), and a worse actuarial probability of survival (1-year mortality, 64% vs. 20%; P < 0.002). Conclusions: Early measurement of HVPG in cirrhotic patients during acute variceal bleeding provides useful prognostic information on the evolution of the,bleeding episode and long-term survival.