The value of hepatic vein pressure gradient in assessing the risk of rebleeding after endoscopic treatment of esophageal variceal bleeding in cirrhotic patients

Abstract

Abstract: Objective To explore the values of serum type IV collagen (CIV) and vitamin B12 levels, and hepatic vein pressure gradient (HVPG) measurements in assessing the risk of rebleeding after endoscopic treatment in patients with esophageal variceal bleeding (EVB) due to cirrhosis. Methods A case-control study was performed on 61 patients with cirrhosis and EVB who underwent endoscopic venous ligation surgery in Weiyuan County People's Hospital between April 2019 and April 2021. These patients experienced recurrent bleeding within 24 months after surgery and were selected as the bleeding group. Additionally, 80 patients who underwent the same surgery without experiencing recurrent bleeding within 24 months of follow-up post surgery were selected as the control group. The preoperative serum levels of CIV and vitamin B12, and the measured value of HVPG of the two groups of patients were compared, The values of the aboval three indicators in predicting postoperative rebleeding in patients were compared with receiver operating curve (ROC) analysis and logistic regression model. Results The preoperative serum levels of CIV and vitamin B12, and the value of HVPG in patients with recurrent bleeding were (117.4 ± 28.0) μg/L, (498.6 ± 84.0) pg/mL, and (21.9 ± 4.4) mmHg, respectively, which were significantly higher than those of [96.3 ± 17.5] μg/L, (421.8 ± 78.0) pg/mL, (15.6 ± 3.3) mmHg, respectively in the non-rebleeding group (P<0.05); The sensitivities of preoperative CIV, vitamin B12, and HVPG for predicting postoperative bleeding were 68.27%, 73.81%, and 90.66%; the specificities were 65.43%, 76.46%, and 81.52%, respectively; and AUC values were 0.716,0.791, 0.893.The logistic regression model showed that the longer the course of esophageal varices in cirrhotic patients, complicated with portal vein thrombosis, the increments in INR value, CIV value, vitamin B12 level, and the measured value of hepatic vein pressure gradient are risk factors for rebleeding after endoscopic treatment (OR values=1.636, 2.079, 1.493, 1.402, 1.507, 1.790, respectively, all P<0.05), The elevations of PLT count and Alb level were protective factors for patients with recurrent bleeding after endoscopic treatment (POR values were 0.531 and 0.618, respectively, P<0.05). Conclusion The serum levels of CIV and vitamin B12, and HVPG measurement before endoscopic treatment in cirrhotic patients with EVB were closely related to the risk of postoperative bleeding, which is of great significance for predicting the prognosis of EVB and for guiding the clinical treatment.

Key words: Type IV collagen, Vitamin B12, Hepatic vein pressure gradient, Liver cirrhosis, Esophageal variceal bleeding

LIU Jie¹, LIU Tang², WEN Wei¹, TANG Shi-xiao³. The value of hepatic vein pressure gradient in assessing the risk of rebleeding after endoscopic treatment of esophageal variceal bleeding in cirrhotic patients[J]. Chinese Hepatolgy, 2023, 28(10): 1162-1166.

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