Affiliations: Gastrointestinal Bleeding Unit. Department of
Gastroenterology. Hospital de la Santa Creu i Sant Pau, Autonomous University,
Barcelona, Spain | Centro de Investigación Biomédica en Red de
Enfermedades Hepáticas y Digestivas (CIBEREHD o Ciberehd), Barcelona, Spain
Note: [] Corresponding author: Càndid Villanueva, Gastroenterology
Department, Hospital Santa Creu i Sant Pau, Mas Casanovas, 90. 08025 Barcelona,
Spain. Tel.: +34 93 556 59 20; Fax: +34 93 556 56 08; E-mail: [email protected]
Abstract: Prognostic markers of compensated cirrhosis should mainly
investigate factors involved with progression to decompensation because death
in cirrhosis is related with decompensation. Portal hypertension plays a
crucial role in the pathophysiology of most complications of cirrhosis.
Accordingly, HVPG monitoring has strong prognostic value. An HVPG
⩾ 10 mmHg determines a significantly higher risk of
developing decompensation. Esophageal varices also can develop when the HVPG is
⩾ 10 mmHg, although an HVPG ⩾ 12
mmHg is required for variceal bleeding to occur. Monitoring the changes induced
by the treatment of portal hypertension on HVPG, provides strong prognostic
information. In compensated cirrhosis hemodynamic response is appropriate when
the HVPG decreased to < 10 mmHg or by >
10% from baseline, because the incidence of complications such as bleeding or
ascites significantly decrease when these targets are achieved. Whether serum
markers, such as the FibroTest, they, may be valuable to predict decompensation
should be established. Transient Elastography is a promising technique that has
shown an excellent accuracy to detect severe portal hypertension. However,
whether it can adequately determine clinically significant portal hypertension,
and risk of developing varices and decompensation, should be established.
Magnetic Resonance Elastography is also promising.
