Changes in Hepatic Venous Pressure Gradient Predict Hepatic Decompensation in Patients Who Achieved Sustained Virologic Response to Interferon-Free Therapy

摘要: BACKGROUND AND AIMS Sustained virologic response (SVR) to interferon (IFN)-free therapies ameliorates portal hypertension (PH); however, it remains unclear whether a decrease in hepatic venous pressure gradient (HVPG) after cure of hepatitis C translates into clinical benefit. We assessed the impact pretreatment HVPG, changes and posttreatment HVPG on development decompensation patients with PH who achieved SVR IFN-free therapy. Moreover, we evaluated transient elastography (TE) von Willebrand factor platelet count ratio (VITRO) as noninvasive methods for monitoring evolution PH. APPROACH RESULTS The study comprised 90 HVPG ≥ 6 mm Hg underwent paired TE, VITRO assessments before (baseline [BL]) (follow-up [FU]) FU but not BL predicted (per mm Hg, hazard ratio, 1.18; 95% confidence interval, 1.08-1.28; P < 0.001). Patients HVPG ≤ 9 mm Hg or resolved clinically significant (CSPH) were protected from decompensation. In CSPH, an decrease ≥ 10% was similarly protective (36 months, 2.5% vs. 40.5%; P < 0.001) observed substantially higher proportion (60% 24%; Importantly, performance such TE/VITRO diagnosing reduction ≥ 10% inadequate use (area under receiver operating characteristic curve [AUROC],  < 0.8), emphasizing need measurements. However, able rule out CSPH (AUROC, 0.86-0.92) most patients, especially if sequential manner. CONCLUSIONS Reassessment improved prognostication CSPH. An "immediate" majority these associated benefit, prevented These results support surrogate endpoint interventions that lower by decreasing intrahepatic resistance.