Increase in Free Hepatic Venous Pressure Response to Beta-Blockers Predicts Variceal Bleeding in Cirrhotic Patients

Abstract

Background and Aims. Nonselective beta-blockers (NSBBs) are the main drug to prevent portal hypertension. It could alter free hepatic venous pressure (FHVP); however, the significance is unknown. This prospective study was to explore the change of FHVP after use of NSBBs and its predictive value for gastroesophageal varices (GOV) bleeding in cirrhotic patients. Patients and Methods. Cirrhotic patients with medium-large GOV between September 2014 and January 2019 were enrolled. After initial hepatic venous pressure gradient (HVPG) measurement, patients received oral NSBBs. Seven days later, the secondary HVPG was examined to evaluate the FHVP alteration and hemodynamic response. The variceal bleeding between patients with FHVP increased and decreased/unchanged was compared. Results. A total of 74 patients were enrolled, and 62 patients completed the secondary HVPG measurement and was followed up. The cumulative bleeding rate was significantly higher in patients with $\text{FHVP}\text{increased}\ge 1.75$  mmHg than those with FHVP decreased/unchanged (54.5% vs. 22.5%, $p=0.021$ ), while there was no significant difference in bleeding between HVPG responders and nonresponders (32.6% vs. 37.5%, $p=0.520$ ). For HVPG responders, variceal bleeding in patients with $\text{FHVP}\text{increased}\ge 1.75$  mmHg was significantly more than that in patients with FHVP decreased/unchanged (57.9% vs. 28.6%, $p=0.041$ ). Cox regression analysis showed that change of FHVP was an independent predictor of variceal bleeding. Conclusion. $\text{Increase}\ge 1.75$  mmHg in FHVP responding to beta-blockers in cirrhotic patients with GOV indicates high risk of variceal bleeding. Besides HVPG response, change of FHVP should also be valued in hemodynamic evaluation to beta-blockers. This trial is registered with Chinese Clinical Trial Registry ChiCTR-IPR-17012836.