Single portal pressure measurement predicts survival in cirrhotic patientswith recent bleeding

Background-Height of portal pressure correlates with severity of alcoholic cirrhosis. Portal pressure indices are not however used routinely as predic tors of survival. Aims-To examine the clinical value of a single portal pressure measurement in predicting outcome in cirrhotic patients who have bled. Methods-A series of 105 cirrhotic patients who consecutively under ent hepa tic venous pressure measurement were investigated. The main cause of cirrho sis was alcoholic (64.8%) and prior to admission all patients had bled from varices. Results-During the follow up period (median 566 days, range 10-2555), 33 pa tients died, and 54 developed variceal haemorrhage. Applying Cox regression analysis, hepatic venous pressure gradient, bilirubin, prothrombin time? a scites, and previous long term endoscopic treatment were the only statistic ally independent predictors of survival, irrespective of cirrhotic aetiolog y. The predictive value of the pressure gradient was much higher if the mea surement was taken within the first or the second week from the bleeding an d there was no association after 15 days. A hepatic venous pressure gradien t of at least 16 mm Hg appeared to identify patients with a greatly increas ed risk of dying. Conclusions-Indirectly measured portal pressure is an independent predictor of survival in patients with both alcoholic and non-alcoholic cirrhosis. I n patients with a previous variceal bleeding episode this predictive value seems to be better if the measurement is taken within the first two weeks f rom the bleeding episode. A greater use of this technique is recommended fo r the prognostic assessment and management of patients with chronic liver d isease.