Cirrhosis and portal hypertension: The importance of risk stratification, the role of hepatic venous pressure gradient measurement

Table 1 Natural history of cirrhosis

	Stages of cirrhosis
	Mortality risk at 1 yr
	Low	Intermediate	High
	≤ 1%	1%-20%	> 20%
Clinical features	Asymptomatic no varices	Varices/ascites or both	Bleeding/re-bleeding SBP Refractory ascites HRS/AKI Infection other than SBP
HVPG of risk	10 mmHg		12/16/20 mmHg
Main outcome to prevent	Decompensation and/or HCC and/or varices	Decompensation and/or HCC mortality	HCC and/or mortality
Main pathophysiologic factor	Intrahepatic structural and hemodynamic changes Portal pressure	Extrahepatic hemodynamic changes Portal pressure	Hepatocellualr dysfunction Portal pressure Cytokine release Peripheral perfusion Coagulopathy? Other?

Each category of risk is presented with the clinical features, the hepatic venous pressure gradient value, the main outcome to prevent, the main pathophysiologic factor related with that category of risk. SBP: Spontaneous bacterial peritonitis; HRS: Hepato-renal syndrome; AKI: Acute kidney injury; HCC: Hepatocellular carcinoma; ACLF: Acute on chronic liver failure; HVPG: Hepatic venous pressure gradient.