{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:44:24Z","timestamp":1786977864792,"version":"build-2736575974"},"reference-count":42,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2020,7,6]],"date-time":"2020-07-06T00:00:00Z","timestamp":1593993600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2020,7,6]],"date-time":"2020-07-06T00:00:00Z","timestamp":1593993600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatology"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>A hepatic venous pressure gradient (HVPG) decrease of 20% or more (or \u226412\u00a0mm\u00a0Hg) indicates a good prognosis during propranolol\/nadolol treatment but requires two HVPG measurements. We aimed to simplify the risk stratification after variceal bleeding using clinical data and HVPG.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 193 patients with cirrhosis (62% with ascites and\/or hepatic encephalopathy [HE]) who were within 7 days of bleeding had their HVPG measured before and at 1\u20103\u00a0months of treatment with propranolol\/nadolol plus endoscopic band ligation. The endpoints were rebleeding and rebleeding\/transplantation\u2010free survival for 4 years. Another cohort (n\u00a0=\u00a0231) served as the validation set.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During follow\u2010up, 45 patients had variceal bleeding and 61 died. The HVPG responders (n\u00a0=\u00a071) had lower rebleeding risk (10% vs. 34%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a00.001) and better survival than the 122 nonresponders (61% vs. 39%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a00.001). Patients with HE (n\u00a0=\u00a0120) had lower survival than patients without HE (40% vs. 63%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a00.005). Among the patients with ascites\/HE, those with baseline HVPG\u00a0\u2264\u00a016\u00a0mm\u00a0Hg (n\u00a0=\u00a016) had a low rebleeding risk (13%). In contrast, among patients with ascites\/HE and baseline HVPG\u00a0&gt;\u00a016\u00a0mm\u00a0Hg, only the HVPG responders (n\u00a0=\u00a032) had a good prognosis, with lower rebleeding risk and better survival than the nonresponders (n\u00a0=\u00a072) (respective proportions: 7% vs. 39%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a00.018; 56% vs. 30%\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a00.010). These findings allowed us to develop a strategy for risk stratification in which HVPG response was measured only in patients with ascites and\/or HE and baseline HVPG\u00a0&gt;\u00a016\u00a0mm\u00a0Hg. This method reduced the \u201cgray zone\u201d (i.e., high\u2010risk patients who had not died on follow\u2010up) from 46% to 35% and decreased the HVPG measurements required by 42%. The validation cohort confirmed these results.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Restricting HVPG measurements to patients with ascites\/HE and measuring HVPG response only if the patient\u2019s baseline HVPG is over 16\u00a0mm\u00a0Hg improves detection of high\u2010risk patients while markedly reducing the number of HVPG measurements required.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hep.31125","type":"journal-article","created":{"date-parts":[[2020,1,21]],"date-time":"2020-01-21T01:41:39Z","timestamp":1579570899000},"page":"1353-1365","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":56,"title":["A Prognostic Strategy Based on Stage of Cirrhosis and HVPG to Improve Risk Stratification After Variceal Bleeding"],"prefix":"10.1097","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4685-7184","authenticated-orcid":false,"given":"Vincenzo","family":"La Mura","sequence":"first","affiliation":[{"name":"Hepatic Hemodynamic Laboratory, Liver Unit,Hospital Clinic\u2013IDIBAPS,University of Barcelona,Barcelona,Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas (Ciberehd),Barcelona,Spain"},{"name":"Fondazione IRCCS Ca\u2019 Granda, Ospedale Maggiore Policlinico, Medicina Generale\u2013Emostasi e Trombosi,Milano,Italy"},{"name":"CRC \u201cA.M. e A. Migliavacca\u201d per lo Studio e la Cura delle Malattie del Fegato,Milano,Italy"},{"name":"Dipartimento di Scienze Biomediche per la Salute,Universit\u00e0 Degli Studi di Milano,Milano,Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Garcia\u2010Guix","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas (Ciberehd),Barcelona,Spain"},{"name":"Gastrointestinal Bleeding Unit,Department of Gastroenterology,Hospital de Sant Pau, Autonomous University,Barcelona,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annalisa","family":"Berzigotti","sequence":"additional","affiliation":[{"name":"Hepatic Hemodynamic Laboratory, Liver Unit,Hospital Clinic\u2013IDIBAPS,University of Barcelona,Barcelona,Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas (Ciberehd),Barcelona,Spain"},{"name":"Swiss Liver, Hepatology,University Clinic for Visceral Medicine and Surgery, Inselspital,University of Bern,Bern,Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan G.","family":"Abraldes","sequence":"additional","affiliation":[{"name":"Hepatic Hemodynamic Laboratory, Liver Unit,Hospital Clinic\u2013IDIBAPS,University of Barcelona,Barcelona,Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas (Ciberehd),Barcelona,Spain"},{"name":"Division of Gastroenterology,University of Alberta,Edmonton,AB,Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9032-4954","authenticated-orcid":false,"given":"Juan Carlos","family":"Garc\u00eda\u2010Pag\u00e1n","sequence":"additional","affiliation":[{"name":"Hepatic Hemodynamic Laboratory, Liver Unit,Hospital Clinic\u2013IDIBAPS,University of Barcelona,Barcelona,Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas (Ciberehd),Barcelona,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3674-914X","authenticated-orcid":false,"given":"Candid","family":"Villanueva","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas (Ciberehd),Barcelona,Spain"},{"name":"Gastrointestinal Bleeding Unit,Department of Gastroenterology,Hospital de Sant Pau, Autonomous University,Barcelona,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3414-0055","authenticated-orcid":false,"given":"Jaime","family":"Bosch","sequence":"additional","affiliation":[{"name":"Hepatic Hemodynamic Laboratory, Liver Unit,Hospital Clinic\u2013IDIBAPS,University of Barcelona,Barcelona,Spain"},{"name":"Centro de 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