HEMODYNAMIC PARAMETERS PREDICTING VARICEAL HEMORRHAGE AND SURVIVAL INALCOHOLIC CIRRHOSIS

The relationship between the various haemodynamic abnormalities observ ed in cirrhosis and their prognostic value remains unclear. We report haemodynamic measurements on 96 patients with alcoholic cirrhosis (mea n Childs-Pugh Score, CPS, 9.0 +/- 0.2, mean age 55.6 +/- 1.0 years) an d assess their value in predicting variceal bleeding and death during a mean follow-up of 19.3 +/- 1.5 months. Baseline CPS correlated with hepatic venous pressure gradient (HVPG) (p=0.001), azygos blood flow ( p<0.05), cardiac index (p<0.05), and inversely with mean arterial pres sure (p<0.01) and systemic vascular resistance index (p<0.05). Renal b lood flow was not related to any haemodynamic parameter or CPS. Thirty -eight patients died during follow-up, and 16 had a variceal bleed. De ath (p=0.001) and variceal bleeding (p<0.05) were more likely in patie nts with HVPG >16 mmHg than in those with HVPG <16 mmHg, and variceal bleeding was more likely in patients with HVPG >12mmHg (vs. HVPC <12mm Hg, p<0.05). HVPC also predicted death and variceal haemorrhage on uni variate and multivariate analyses. No other haemodynamic parameter pre dicted death or bleeding. In alcoholic cirrhosis, severity of liver di sease is related to HVPG, collateral blood flow and degree of systemic circulatory abnormalities. HVPC is a useful predictor of survival and variceal bleeding in these patients.