Varices on computed tomography are surrogate of clinically significant portal hypertension and can predict survival in compensated cirrhosis patients.

Abstract

To investigate prognostic value of varices on computed tomography (CT) and redefine surrogate criteria for clinically significant portal hypertension (CSPH). We retrospectively enrolled 241 patients with compensated cirrhosis who underwent hepatic venous pressure gradient (HVPG) measurement from 2008 to 2013. Using CT and upper endoscopy findings obtained within 3months from HVPG measurement, patients were classified into three groups: presence of standard surrogate for CSPH, defined as presence of varices on upper endoscopy and/or splenomegaly associated with thrombocytopenia (Group 1, n=139); varices on CT without standard surrogate for CSPH (Group 2, n=41); and free from both (Group 3, n=61). HVPG value and overall survival (OS) rates were compared among three patient groups. Revised surrogate for CSPH was defined as presence of standard surrogate and/or presence of varices on CT (i.e. both Group 1 and Group 2). Mean HVPG value in Group 2 was significantly higher than that in Group 3 (10.3mmHg vs 6.5mmHg, P<0.001), but significantly lower than that in Group 1 (10.3mmHg vs 13.1mmHg, P<0.001). Seven-year OS rates in Group 2 was similar to those in Group 1 (57.0% vs 62.7%, P=0.591), but significantly poorer than those in Group 3 (57.0% vs 84.0%, P=0.015). The presence of revised surrogate for CSPH was a significant predictive factor for OS (P=0.025, Hazard ratio=2.71 [1.14-6.45]) on multivariate analysis whereas standard surrogate for CSPH was not (P=0.849). The presence of varices on CT was a significant sign for CSPH, predicting poor OS outcome in patients with compensated cirrhosis.