SNFGE SNFGE
 
Thématique :
- Foie
Originalité :
Réexamen
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Hepatology
  2015/11  
 
  2015 Nov;62(5):1584-92  
  doi: 10.1002/hep.28031  
 
  The prognostic value of hepatic venous pressure gradient in patients with cirrhosis is highly dependent on the accuracy of the technique.  
 
  Silva-Junior G, Baiges A, Turon F, Torres F, Hernández-Gea V, Bosch J, García-Pagán JC  
  http://www.ncbi.nlm.nih.gov/pubmed/?term=The+prognostic+value+of+hepatic+venous+pressure+gradient+in+patients+with+cirrhosis+is+highly+dependent+on+the+accuracy+of+the+technique.  
 
 

Hepatic venous pressure gradient (HVPG), the difference between wedged (WHVP) and free hepatic vein pressure (FHVP), predicts survival in patients with cirrhosis. It has been suggested for the use of inferior vena cava (IVC) value instead of FHVP to calculate HVPG when the difference between proximal FHVP (obtained at 2 cm from the hepatic vein outlet) and IVC (measured at the level of the hepatic ostium) is >2 mm Hg. However, there are no data supporting this recommendation. The main aim of the study was to establish which gradient, WHVP-FHVP (HVPG-Free) or WHVP-IVC (HVPG-IVC), better correlates with orthotopic liver transplantation (OLT)-free survival. This work was a retrospective evaluation of hepatic hemodynamic studies of 380 consecutive patients with cirrhosis performed from January 2006 to December 2012 with follow-up until December 2013. Patients had a mean age of 56 ± 10 years and 64.7% were men. Mean Child-Pugh was 7 ± 2. HVPG-Free (16 ± 5 mm Hg) was significantly lower than HVPG-IVC (17 ± 5.5 mm Hg; P < 0.001). During a mean follow-up of 43 months, 40 patients were transplanted and 111 died. A total of 285 (75%) patients had an FHVP-IVC difference within ±2 mm Hg (no discrepancy) and 95 (25%) patients <-2 mm Hg or >2 mm Hg (discrepancy). In patients without discrepancy, 16 mm Hg was the best cut-off value predicting survival, independently of being calculated as HVPG-Free or HVPG-IVC. However, in those patients with discrepancy, 16 mm Hg was still the best cut-off value for HVPG-Free, but not for HVPG-IVC, among which 25 patients (26%) were misclassified regarding their risk of OLT/death.

CONCLUSIONS:

Given that WHVP-FHVP was more accurate in assessing prognosis than WHVP-IVC, HVPG should be calculated as the gradient between WHVP and FHVP, but not with IVC, in order to optimize its prognostic value and in identifying different risk population. (Hepatology 2015;62:1584-1592).

 
Question posée
 
Pour calculer le gradient de pression veineux hépatique, doit-on utiliser la différence entre la pression veine hépatique bloquée et la pression veine hépatique libre ou la pression dans la veine cave inférieure ?
 
Question posée
 
Cette étude rétrospective de 380 patients a été effectuée par l’équipe de référence de Barcelone. Le gradient établi par la différence pression libre / pression bloquée est plus pertinent. Le cutoff prédictif de la survie dans ce cas est de 16 mmHg.
 
Commentaires

La plupart des centres français utilisent la technique la plus pertinente donc pas de nécessité de changement.

 
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