Effect factors analysis of propranolol decreasing hepatic venous pressure gradient in patients with liver cirrhosis

Abstract

Objective To explore the effect factors of hepatic venous pressure gradient (HVPG) responsed to propranolol used to prevent esophageal and gastric varices bleeding (EGVB) in patients with liver cirrhosis and esophageal and gastric varices. Methods From March 2012 to September 2015, 45 patients with liver cirrhosis and esophageal and gastric varices taking propranolol after HVPG measurement were enrolled. After the second HVPG measurement, the patients were divided into HVPG response group and nonresponse group. The demographic features, clinical data, hemodynamic parameters, age, and serum propranolol concentration were compared between the two groups. The t test, chi-square test and rank sum test were performed for statistical analysis. Results Among 45 patients, 28 patients (62.2%) had response and 17 patients did not have HVPG response. There was no statistically significant difference in the age, gender, etiology for liver cirrhosis, liver function and prophylaxis indication between the two groups (all P> 0.05). The decrease of mean arterial pressure of HVPG response group and nonresponse group was 3.0 mmHg (-2.8 mmHg, 9.8 mmHg) (1 mmHg=0.133 kPa) and 1.0 mmHg (-5.5 mmHg, 9.5 mmHg), and the difference was not statistically significant (P>0.05). The basic heart rate of HVPG response group decreased from (68.6±8.6) beat per minute (bpm) before medication treatment to (59.6±7.1) bpm after medication treatment, and the difference was statistically significant (t=4.292, P<0.01). The basic heart rate of nonresponse group decreased from (68.6±7.4) bpm to (60.4±7.5) bpm, and the difference was statistically significant(t=3.217, P=0.003). The amplitudes of decrease of heart rates of response group and nonresponse group were (12.6±9.4)% and (11.5±10.3)%, respectively, and the difference was not statistically significant (t=0.358, P=0.722). After taking propranolol for 144 hours, the serum drug peak concentrations of response group and nonresponse group were 89.5 μg/L (58.5 μg/L, 158.5 μg/L) and 48.0 μg/L (33.5 μg/L, 157.5 μg/L), respectively, and there was no statistically significant difference (Z=1.371, P=0.174). Conclusions Age, gender, etiology of liver cirrhosis, liver function, prophylaxis indication, changes of pressure, decreasing of basic heart rate and serum propranolol concentration of patients with liver cirrhosis and esophageal and gastric varices were all not related with HVPG response, and could not precisely predict hemodynamics response. Precise predictiors of hemodynamic response that substitute for HVPG should be further explored. Key words: Liver cirrhosis; Hepatic venous pressure gradient; Propranolol; Hemodynamic response; Forecasting