Etiology Control for Reducing Hepatic Vein Pressure Gradient in Patients With Cirrhosis and Portal Hypertension: A Systematic Review and Meta-Analysis

Abstract

Objectives: Etiological therapy has been documented to improve portal hypertension. We aimed to analyze the effectiveness of etiological therapy on hepatic venous pressure gradient (HVPG) reduction by conducting a systematic review and meta-analysis.

Methods: Literature search of the PubMed, EMBASE, and Cochrane Library was performed to identify studies involving patients with PHT published up to January 2024. The absolute HVPG reduction and the HVPG response rate were assessed. Pooled analyses were performed using random-effects models, and the heterogeneity was evaluated using sensitivity and subgroup analyses.

Results: Altogether 21 studies were included for analysis. After etiological therapy, the absolute reduction in HVPG was 2.25 mmHg (95% confidence interval [CI] 1.80–2.71). Longer (> 1 year) duration of etiological therapy showed more significant HVPG reduction compared with those treated with 1 year or less (3.02 mmHg vs. 2.24 mmHg, p = 0.001). A more pronounced HVPG reduction was also observed in patients with viral hepatitis-induced cirrhosis than in those with non-viral hepatitis-induced cirrhosis (2.39 mmHg vs. 1.27 mmHg, p = 0.001). Furthermore, 64% and 41% of patients showed ≥ 10% HVPG reduction and a reduction of ≥ 20% or to ≤ 12 mmHg, respectively, after etiology control.

Conclusion: Effective etiology control can significantly decrease HVPG and increase the HVPG response rate, which may contribute to the improvement of the prognosis of cirrhotic patients.

Keywords

etiology control / hepatic venous pressure gradient / meta-analysis / portal hypertension

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2025 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.