Published online Apr 8, 2015. doi: 10.4254/wjh.v7.i4.688
Peer-review started: August 29, 2014
First decision: October 14, 2014
Revised: November 11, 2014
Accepted: January 9, 2015
Article in press: January 12, 2015
Published online: April 8, 2015
Portal hypertension is the main prognostic factor in cirrhosis. The recent emergence of potent antiviral drugs and new algorithm of treatment for the management of complications due to portal hypertension have sensibly changed our perception of cirrhosis that can be now considered as a multistage liver disease whose mortality risk can be reduced by a tailored approach for any stage of risk. Experts recommend to move toward a pathophysiological classification of cirrhosis that considers both structural and functional changes. The hepatic venous pressure gradient HVPG, is the reference gold standard to estimate the severity of portal hypertension in cirrhosis. It correlates with both structural and functional changes that occur in cirrhosis and carries valuable prognostic information to stratify the mortality risk. This article provides a general overview of the pathophysiology and natural course of cirrhosis and portal hypertension. We propose a simplified classification of cirrhosis based on low, intermediate and high mortality stage. The prognostic information provided by HVPG is presented according to each stage. A comparison with prognostic models based on clinical and endoscopic variables is discussed in order to evidence the additional contribute given by HVPG on top of other clinical and instrumental variables widely used in clinical practice.
Core tip: Recently a pathophysiological classification of cirrhosis has been strongly encouraged. Hepatic venous pressure gradient (HVPG) measurement is the most reliable tool to estimate the severity of portal hypertension in cirrhosis but several methodological concerns have limited its use in clinical practice. The article summarizes the results published about the prognostic value of HVPG and originally offers a critical revision of the information provided by this hemodynamic parameter on top of the most widely used models based on non-hemodynamic parameters.