Hepatic venous pressure gradient predicts risk of hepatic decompensation and liver-related mortality in patients with MASLD
Paternostro, Rafael (Medical University of Vienna)
Kwanten, Wilhelmus (University of Antwerp)
Hofer, Benedikt Silvester (Medical University of Vienna)
Semmler, Georg (Medical University of Vienna)
Bagdadi, Ali (University Hospital Antwerp (Bèlgica))
Luzko, Irina (Hospital Clínic i Provincial de Barcelona)
Hernández-Gea, Virginia (Hospital Clínic i Provincial de Barcelona)
Graupera, Isabel (Hospital Clínic i Provincial de Barcelona)
García-Pagán, JC. (Hospital Clínic i Provincial de Barcelona)
Saltini, Dario (Azienda Ospedaliero-Universitaria di Modena)
Indulti, Federica (Azienda Ospedaliero-Universitaria di Modena)
Schepis, Filippo (Azienda Ospedaliero-Universitaria di Modena)
Moga, Lucile (Centre de Référence des Maladies Vasculaires du Foie)
Rautou, Pierre-Emmanuel (Centre de Référence des Maladies Vasculaires du Foie)
Llop, Elba (Universidad Autónoma de Madrid)
Téllez, Luis (Hospital Universitario Ramón y Cajal (Madrid))
Albillos, Agustín (Hospital Universitario Ramón y Cajal (Madrid))
Fortea, Jose Ignacio (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))
Puente, Angela (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))
Tosetti, Giulia (University of Milan)
Primignani, Massimo (University of Milan)
Zipprich, Alexander (Jena University Hospital (Alemania))
Vuille-Lessard, Elise (University of Bern)
Berzigotti, Annalisa (University of Bern)
Taru, Madalina Gabriela ("Iuliu Hatieganu" University of Medicine and Pharmacy)
Taru, Vlad ("Iuliu Hatieganu" University of Medicine and Pharmacy)
Procopet, Bogdan ("Iuliu Hatieganu" University of Medicine and Pharmacy)
Jansen, Christian (University Hospital Bonn (Bonn, Alemanya))
Praktiknjo, Michael (University Hospital of Münster)
Gu, Wenyi (University Hospital of Münster)
Trebicka, Jonel (University Hospital of Münster)
Ibáñez-Samaniego, Luis (Hospital General Universitario Gregorio Marañón)
Bañares, Rafael (Hospital General Universitario Gregorio Marañón)
Rivera Esteban, Jesús (Vall d'Hebron Institut de Recerca (VHIR))
Pericàs, Juan M. (Vall d'Hebron Institut de Recerca (VHIR))
Genescà Ferrer, Joan (Vall d'Hebron Institut de Recerca (VHIR))
Alvarado-Tapias, Edilmar (Institut de Recerca Sant Pau)
Villanueva, Càndid (Institut de Recerca Sant Pau)
Larrue, Helene (University of Toulouse)
Bureau, Christophe (University of Toulouse)
Laleman, Wim (UZ Leuven)
Ardevol, Alba (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Masnou, Helena (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Vanwolleghem, Thomas (University of Antwerp)
Trauner, Michael (Medical University of Vienna)
Mandorfer, Mattias (Medical University of Vienna)
Francque, Sven (University of Antwerp)
Reiberger, Thomas (Medical University of Vienna)

Data:	2024
Resum:	Background & Aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a leading cause of advanced chronic liver disease (ACLD). Portal hypertension drives hepatic decompensation and is best diagnosed by hepatic venous pressure gradient (HVPG) measurement. Here, we investigate the prognostic value of HVPG in MASLD-related compensated ACLD (MASLD-cACLD). Methods: This European multicentre study included patients with MASLD-cACLD characterised by HVPG at baseline. Hepatic decompensation (variceal bleeding/ascites/hepatic encephalopathy) and liver-related mortality were considered the primary events of interest. Results: A total of 340 patients with MASLD-cACLD (56. 2% male; median age 62 [55-68] years, median MELD 8 [7-9], 71. 2% with diabetes) were included. Clinically significant portal hypertension (CSPH: i. e. , HVPG ≥10 mmHg) was found in 209 patients (61. 5%). During a median follow-up of 41. 5 (27. 5-65. 8) months, 65 patients developed hepatic decompensation with a cumulative incidence of 10. 0% after 2 years (2Y) and 30. 7% after 5 years (5Y) in those with MASLD-cACLD with CSPH, compared to 2. 4% after 2Y and 9. 4% after 5Y in patients without CSPH. Variceal bleeding did not occur without CSPH. CSPH (subdistribution hazard ratio [SHR] 5. 13; p <0. 001) was associated with an increased decompensation risk and a higher HVPG remained an independent risk factor in the multivariable model (adjusted SHR per mmHg: 1. 12, p <0. 001). Liver-related mortality occurred in 37 patients at a cumulative incidence of 3. 3% after 2Y and 21. 4% after 5Y in CSPH. Without CSPH, the incidence after 5Y was 0. 8%. Accordingly, a higher HVPG was also independently associated with a higher risk of liver-related death (adjusted SHR per mmHg: 1. 20, p <0. 001). Conclusion: HVPG measurement is of high prognostic value in MASLD-cACLD. In patients with MASLD-cACLD without CSPH, the short-term risk of decompensation is very low and liver-related mortality is rare, while the presence of CSPH substantially increases the risk of both. Impact and implications: While the incidence of compensated advanced chronic liver disease (cACLD) due to metabolic dysfunction-associated steatotic liver disease (MASLD) is increasing worldwide, insights into the impact of clinically significant portal hypertension (CSPH) on the risk of liver-related events in MASLD-cACLD remain limited. Based on the findings of this European multicentre study including 340 MASLD-cACLD patients, we could show that increasing HVPG values and the presence of CSPH in particular were associated with a significantly higher risk of first hepatic decompensation and liver-related mortality. In contrast, the short-term incidence of decompensation in patients with MASLD-cACLD without CSPH was low and the risk of liver-mortality remained negligible. Thus, HVPG measurements can provide important prognostic information for individualised risk stratification in MASLD-cACLD and may help facilitate the study of novel and promising treatment possibilities for MASLD.
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Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	MASLD ; Advanced chronic liver disease ; Hepatic decompensation ; Hepatic venous pressure gradient ; Portal hypertension
Publicat a:	Journal of hepatology, Vol. 81, Núm. 5 (November 2024) , p. 827-836, ISSN 1600-0641

DOI: 10.1016/j.jhep.2024.05.033

11 p, 738.5 KB

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