Establishment and assessment of the hepatic venous pressure gradient using biofluid mechanics (HVPGBFM): protocol for a prospective, randomised, non-controlled, multicentre study.

INTRODUCTION: Portal hypertension (PH) is a severe disease with a poor outcome. Hepatic venous pressure gradient (HVPG), the current gold standard to detect PH, is available only in few hospitals due to its invasiveness and technical difficulty. This study aimed to establish and assess a novel model to calculate HVPG based on biofluid mechanics. METHODS AND ANALYSIS: This is a prospective, randomised, non-controlled, multicentre trial. A total of 248 patients will be recruited in this study, and each patient will undergo CT, blood tests, Doppler ultrasound and HVPG measurement. The study consists of two independent and consecutive cohorts: original cohort (124 patients) and validation cohort (124 patients). The researchers will establish and improve the HVPG using biofluid mechanics (HVPGBFM)model in the original cohort and assess the model in the validation cohort. ETHICS AND DISSEMINATION: The study was approved by the Scientific Research Projects Approval Determination of Independent Ethics Committee of Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (approval number 2017-430 T326). Study findings will be disseminated through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER: NCT03470389.

Portopulmonary hypertension in cirrhotic patients: Prevalence, clinical features and risk factors.

The incidence and clinical features of portopulmonary hypertension (POPH) have not been adequately described and it is currently unknown whether an association exists between the severity of POPH and liver function. Additionally, POPH risk factors are yet to be identified. The aim of this study was to determine the prevalence, describe the clinical features and investigate the potential risk factors of POPH. We conducted a study of 100 cirrhotic patients hospitalized between March 2011 and May 2012 at Tongji Hospital in Shanghai. The clinical characteristics of patients with and without POPH were analyzed. Clinical variables with a possible association with POPH were measured and pulmonary artery systolic pressure (PASP) was determined by cardiac Doppler echocardiography. Of the 100 patients enrolled in this study, 10 were diagnosed with POPH. Seven of the cases were mild, two were moderate and only one was severe; eight were attributed to viral infections. POPH was not detected in patients with schistosomal or alcoholic cirrhosis. Hemoglobin (Hb) levels were lower in patients with POPH compared to those without POPH (P<0.01) and the severity of POPH was not significantly correlated with Child-Pugh grade (R=-0.06, P=0.09). Hb levels, incidence of hepatitis C virus (HCV) infection and portal vein thrombosis differed between the two groups (P<0.05). Hb levels were identified as an independent risk factor associated with POPH and portal vein thrombosis may play an important role during the development of POPH. However, the severity of POPH was not associated with liver function.