Hepatic venous pressure gradient predicts risk of hepatic decompensation and liver-related mortality in patients with MASLD.

Paternostro, Rafael; Kwanten, Wilhelmus J; Hofer, Benedikt Silvester; Semmler, Georg; Bagdadi, Ali; Luzko, Irina; Hernández-Gea, Virginia; Graupera, Isabel; García-Pagán, Juan Carlos; Saltini, Dario; Indulti, Federica; Schepis, Filippo; Moga, Lucile; Rautou, Pierre-Emanuel; Llop, Elba; Téllez, Luis; Albillos, Agustín; Fortea, Jose Ignacio; Puente, Angela; Tosetti, Giulia; ... (2024). Hepatic venous pressure gradient predicts risk of hepatic decompensation and liver-related mortality in patients with MASLD. (In Press). Journal of hepatology Elsevier 10.1016/j.jhep.2024.05.033

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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 compensated (cACLD) MASLD.

METHODS

This European multicentre study included MASLD-cACLD patients characterised by HVPG at baseline. Hepatic decompensation (variceal bleeding/ ascites/hepatic encephalopathy) and liver-related mortality were considered the primary events of interest.

RESULTS

340 MASLD-cACLD patients [56.2% men; age: 62 (55-68) years; MELD: 8 (7-9); 71.2% 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 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 (aSHR per mmHg:1.12; p<0.001). Liver-related mortality occurred in 37 patients with 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 (aSHR per mmHg:1.20; p<0.001).

CONCLUSION

HVPG measurement is of high prognostic value in MASLD-cACLD. While MASLD-cACLD patients without CSPH show a very low short-term risk of decompensation and liver-related mortality is rare, the presence of CSPH substantially increases both risks.

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, 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 MASLD-cACLD patients 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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Hepatology
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine

UniBE Contributor:

Vuille-Lessard, Elise, Berzigotti, Annalisa

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1600-0641

Publisher:

Elsevier

Language:

English

Submitter:

Pubmed Import

Date Deposited:

03 Jun 2024 12:44

Last Modified:

04 Jun 2024 15:29

Publisher DOI:

10.1016/j.jhep.2024.05.033

PubMed ID:

38823501

Uncontrolled Keywords:

MASLD advanced chronic liver disease hepatic decompensation hepatic venous pressure gradient portal hypertension

BORIS DOI:

10.48350/197450

URI:

https://boris.unibe.ch/id/eprint/197450

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