BACKGROUND & AIMS In unselected patients with cirrhosis, those with reductions in hepatic venous pressure gradient (HVPG) to below a defined threshold (responders) have a reduced risk of variceal hemorrhage (VH) and death. We performed a meta-analysis to compare this effect in patients with vs without ascites. METHODS We collected data from 15 studies of primary or secondary prophylaxis of VH that reported data on VH and death in responders vs nonresponders. We included studies in which data on ascites at baseline and on other relevant outcomes during follow-up evaluation were available. We performed separate meta-analyses for patients with vs without ascites. RESULTS Of the 1113 patients included in the studies, 968 patients (87%) had been treated with nonselective β-blockers. In 993 patients (89%), HVPG response was defined as a decrease of more than 20% from baseline (>10% in 11% of patients) or to less than 12 mm Hg. In the 661 patients without ascites, responders (n = 329; 50%) had significantly lower odds of events (ascites, VH, or encephalopathy) than nonresponders (odds ratio [OR], 0.35; 95% CI, 0.22-0.56). Odds of death or liver transplantation were also significantly lower among responders than nonresponders (OR, 0.50, 95% CI, 0.32-0.78). In the 452 patients with ascites, responders (n = 188; 42%) had significantly lower odds of events (VH, refractory ascites, spontaneous bacterial peritonitis, or hepatorenal syndrome) than nonresponders (OR, 0.27; 95% CI, 0.16-0.43). Overall, odds of death or liver transplantation were lower among responders (OR, 0.47; 95% CI, 0.29-0.75). No heterogeneity was observed among studies. CONCLUSIONS In a meta-analysis of clinical trials, we found that patients with cirrhosis with and without ascites who respond to treatment with nonselective β-blockers (based on reductions in HVPG) have a reduced risk of events, death, or liver transplantation.

中文翻译：

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降低门静脉压力可改善有或无腹水的肝硬化患者的预后：一项荟萃分析。

背景和目的 在未经选择的肝硬化患者中，肝静脉压力梯度 (HVPG) 降低至低于规定阈值的患者（应答者）的静脉曲张出血 (VH) 和死亡风险降低。我们进行了一项荟萃分析来比较腹水患者与无腹水患者的这种效果。方法 我们收集了 15 项 VH 一级或二级预防研究的数据，这些研究报告了 VH 和响应者与无响应者死亡的数据。我们纳入了可获得基线腹水数据和后续评估期间其他相关结果数据的研究。我们对有腹水和无腹水的患者进行了单独的荟萃分析。结果 在纳入研究的 1113 名患者中，968 名患者 (87%) 接受过非选择性 β 受体阻滞剂治疗。在 993 名患者 (89%) 中，HVPG 反应定义为比基线降低 20% 以上（11% 的患者>10%）或低于 12 mm Hg。在 661 名无腹水患者中，有反应者（n = 329；50%）的事件（腹水、VH 或脑病）的几率显着低于无反应者（几率 [OR]，0.35；95% CI，0.22-0.56）。有反应者的死亡或肝移植几率也显着低于无反应者（OR，0.50，95% CI，0.32-0.78）。在 452 名腹水患者中，应答者（n = 188；42%）的事件发生率（VH、顽固性腹水、自发性细菌性腹膜炎或肝肾综合征）显着低于无应答者（OR，0.27；95% CI，0.16-0.43） ）。总体而言，应答者的死亡或肝移植几率较低（OR，0.47；95% CI，0.29-0.75）。研究之间没有观察到异质性。