Prognostic Markers in Patients with Cirrhosis and Portal Hypertension Who Have Not Bled

摘要

Prognostic markers of compensated cirrhosis should mainly investigate factors involved with progression to decompensationbecause death in cirrhosis is related with decompensation. Portal hypertension plays a crucial role in the pathophysiology ofmost complications of cirrhosis. Accordingly, HVPGmonitoring has strong prognostic value. An HVPG ≥ 10 mmHg determinesa 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 treatmentof portal hypertension on HVPG, provides strong prognostic information. In compensated cirrhosis hemodynamic response isappropriate when the HVPG decreased to <10 mmHg or by > 10% from baseline, because the incidence of complications suchas 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 thathas shown an excellent accuracy to detect severe portal hypertension. However, whether it can adequately determine clinicallysignificant portal hypertension, and risk of developing varices and decompensation, should be established. Magnetic ResonanceElastography is also promising.