The independent prognostic value of Perioperative HVPG measurements in patients with portal hypertension and received Laparoscopic splenectomy plus esophagogastric devascularization

The independent prognostic value of Perioperative HVPG measurements in patients with portal hypertension and received Laparoscopic splenectomy plus esophagogastric devascularization | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The independent prognostic value of Perioperative HVPG measurements in patients with portal hypertension and received Laparoscopic splenectomy plus esophagogastric devascularization Ming Zhang, Dong Wang, Xiao Chen, Defeng Liang, Tao Yang, Yanlong Cao, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4567104/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Hepatic venous pressure gradient (HVPG) is considered the gold standard for diagnosing portal hypertension (PHT). Laparoscopic splenectomy plus esophagogastric devascularization (LSED) is an important surgery for treating PHT. However, the variation trend of HVPG after surgery is not clear. In addition, whether HVPG could provide precise prognostic information for patients undergoing surgery remains to be further studied. This study aimed to investigate the independent prognostic value of HVPG in LSED. Methods From January 2016 to March 2023, 134 patients with PHT underwent LSED at our hospital were retrospectively evaluated. The correlations between clinical indicators and history of upper gastrointestinal bleeding (UGIB) were analyzed. Among them, 57 patients remeasured postoperative HVPG. Postoperative alterations of HVPG and correlative factors, as well as the relationship between the HVPG and postoperative UGIB, were further investigated. Results In this study, we found that 93 patients with preoperative UGIB (16.27 ± 5.73mmHg) had a higher baseline HVPG than the other 41 patients without (14.02 ± 5.90mmHg) (P = 0.04). The mean postoperative HVPG significantly decreased (-3.57 ± 8.09 mmHg, P = 0.001) than baseline, 66% of patients (38/57) experienced the decreased HVPG-response after surgery. The baseline HVPG and preoperative CTP class B were associated with the decreased HVPG-response. Additionally, the patients with postoperative HVPG decreased>20% from baseline exhibited better recurrent hemorrhage-free survival rates than those without (log-rank, P = 0.013). Conclusion We found that LSED led to a significantly decreased HVPG, and patients with postoperative HVPG decreased >20% obtained better UGIB-free survival benefits than those without. liver cirrhosis portal hypertension laparoscopic splenectomy plus esophagogastric devascularization hepatic venous pressure gradient Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Portal hypertension (PHT) is a complicated clinical syndrome along with end-stage cirrhosis, which is always caused by the hepatitis B virus (HBV) infection in China. PHT-related complications and symptoms include ascites, hepatic encephalopathy, esophagogastric variceal bleeding (EVB)[1]. Once EVB occurs, the mortality rate of the first bleeding episode is 25%-30%, and the rebleeding rate is 60% if left untreated[2]. The Baveno VII consensus emphasized the hepatic venous pressure gradient (HVPG) as a gold standard to evaluate the presence and severity of PHT[3]. The risk of EVB significantly increases as HVPG increases[4]. Many studies have shown that a sustained reduction in HVPG following treatment is associated with improved clinical outcomes; therefore, a significant decrease in HVPG is considered the most reliable indicator for assessing the efficacy of medical interventions in the management of PHT[5-7]. Therapies for EVB include conservative treatments, endoscopic therapy, interventional therapy and surgical treatment. In China, due to the lack of liver donors, splenectomy plus esophagogastric devascularization has been widely accepted and applied for decades. Considering the high risk of this surgical procedure, LSED was usually recommended for patients with a history of upper gastrointestinal bleeding (UGIB) and/or with a high HVPG (>12 mmHg), and this surgery was also recommended for individuals who did not respond to non-surgical treatments but still had acceptable hepatic reserved function[8]. Along with the rapid development of laparoscopic techniques worldwide, LSED has become a conventional operation with accurate preoperative planning and meticulous intraoperative operations[9]. LSED could effectively alleviate hypersplenism and prevent recurrent EVB in patients with cirrhosis[10, 11]. Until now, to our knowledge, the variation pattern of HVPG accompanied by surgical interventions has not yet been well studied; moreover, the prognosis value of HVPG for perioperative use also needs to be further illustrated. This study aimed to initially reveal the variation pattern of HVPG in the perioperative period of LSED and its potential prognosis value on clinical outcomes in PHT patients received surgical interventions. Patients And Methods Patients : From January 2016 to March 2023, we enrolled patients who were diagnosed with cirrhotic PHT, and received LSED at the Department of General Surgery, the Second Affiliated Hospital of Air Force Military Medical University. This retrospective study only involved patients whose preoperative information was complete. In total, 134 patients were enrolled and divided into two groups according to the preoperative UGIB history. Among the studied population, 57 patients received repeated HVPG measurements in follow-up. The study protocol was approved by the local ethics committee, and informed consent was obtained from each patient. Inclusion and exclusion criteria . Inclusion criteria: (1) the patients with cirrhotic PHT were diagnosed according to clinical characteristics, laboratory tests, imaging, and/or histologic criteria; (2) HVPG measurements were performed for each patient, and a baseline HVPG ＞ 5 mmHg was consistent with the diagnosis of PHT; (3) LSED was performed by a same surgical team; (4) complete follow-up data were available at the hospital. Exclusion criteria:(1) the measurement results of HVPG were inaccurate due to small shunt among hepatic veins; (2) non-cirrhotic cause of PHT; (3) concomitant malignancy; (4) hematological diseases and splenic tumors pathologically diagnosed by bone marrow biopsy or (and) spleen resection; (5) history of transjugular intrahepatic portosystemic shunt or liver surgery; (6) concomitant severe cardio-pulmonary disease and renal failure. (6) with age less than 18 years old or over 75 years old; (7) refused to follow clinical recommendations or lost in follow-up. Surgical methods: the LSED procedure was performed according to a standardized operating procedure as we mentioned before[12]. In brief, we applied five trocars for LSED. After dissecting the gastrocolonic ligament, the splenic artery was separated and ligated initially. The spleen volume was decreased following that, to ensure the safer splenectomy procedure. The spleen was transected with an Endo GIA TM stapler after the dissection of the splenic ligaments. The left gastric vein was cut at root with an Endo GIA TM stapler. The varices along the stomach and abdominal segment of esophagus were cut off. For varicose right gastric vein, we tended to handle it together during the surgery. Then put the spleen into the specimen bag in the abdominal cavity, fragmented and removed through a 2 to 3-cm incision. HVPG measurements : HVPG was measured at the same hospital according to a standardized operating procedure[13]. HVPG measurements were performed with a 7-French balloon catheter (Pejcl Medizintechnik). Specifically, under local anesthesia (lidocaine) and ultrasound guidance, a venous introducer was placed in the right internal jugular vein using the Seldinger technique. A balloon catheter was introduced into the middle hepatic vein or right vein under fluoroscopic guidance, then adequate occlusion of the hepatic vein was confirmed by the absence of backflow and shunt following dye injection. The wedged hepatic venous pressure (WHVP) and free hepatic venous pressure (FHVP) were measured three times in these positions. The HVPG was calculated as the mean difference between three measurements of WHVP and FHVP. Patients were classified according to clinically relevant HVPG cut-off values. (1) Patients were stratified into three groups according to baseline HVPG: the low HVPG group (baseline HVPG＜12 mmHg), the medium HVPG group (baseline HVPG ≥12 mmHg and ＜20 mmHg), and the high HVPG group (HVPG≥20 mmHg). They were associated with a lower risk of EVB, higher risk of EVB, and significantly higher risk of death, respectively[8]. (2) Significant changes in the postoperative HVPG were defined as a decrease of ≥20% from baseline HVPG, as recommended by the Baveno VI consensus[14]. (3) Patients were divided into two groups again based on their postoperative HVPG: the decreased group, including patients showing a reduction in postoperative HVPG from baseline, and the non-decreased group, including patients who did not. Follow-up : The following clinical data before and after surgery were collected for all patients: (1) basic information, including sex, age, cause of cirrhosis, and bleeding history; (2) laboratory test results, including aspartate aminotransferase (AST) level, alanine aminotransferase (ALT) level, platelets (PLT) levels, albumin levels, international normalized ratio (INR), total bilirubin levels, HVPG, and creatinine levels. (3) Imaging assessment: ultrasonography was applied to detect the presence and quantify the volume of ascites. (4) The fibrosis-4 (FIB-4) index was calculated according to the following formula: FIB-4 = age (years)× AST (IU/L)/[PLT(10 9 /L) × ALT ½ (IU/L)][15]. The model for end-stage liver disease (MELD) scores were calculated with the following equation: MELD =9.57×ln [creatinine (mg/dl)]+3.78×ln[bilirubin (mg/dl)] + 11.2×ln(INR) + 6.43 × Etiology (0 for cholestatic and alcoholic cirrhosis, 1 for other causes such as viral cirrhosis)[16]. (6) the follow-up duration was calculated as the time from surgery to one of the following events, whichever occurred first: last follow-up, UGIB, death due to UGIB, or loss to follow-up. The last follow-up date for this study was July 31, 2023. (7) the primary endpoint was recurrent hemorrhage-free survival (RHFS), which was defined as the time from surgery to the first postoperative UGIB[12]. Statistical analysis : Continuous variables with a normal distribution are expressed as the`mean ± standard deviation. Continuous variables with a non-normal distribution were expressed as medians (interquartile ranges: Q1, Q3). Continuous variables were compared between groups using either Student’ s t test for normally distributed data or the Mann-Whitney U test for non-normally distributed data, as assessed by appropriate normality tests. Categorical variables were compared with chi-square or Fisher’s exact tests. Receiver operating characteristic (ROC) curve analysis was used to test the discriminatory power of UGIB. And the area under the ROC curve (AUROC), along with its 95% confidence intervals (CIs), was calculated. Variables with P<0.10 between groups were subsequently selected for inclusion in a multivariate logistic regression analysis. RHFS-rates were analyzed by the Kaplan-Meier (K-M) method and compared by the log-rank test. Univariate cox proportional hazards models were employed to assess the associations between baseline variables and postoperative UGIB events. Variables with p < 0.10 in the univariable analysis were then incorporated into a multivariable cox proportional hazards model to identify independent prognostic factors. P＜0.05 was considered to indicate statistical significance. The analysis was performed with IBM SPSS Statistics for Windows, Version 27.0 (IBM Corp, Armonk, NY). Results Ⅰ. Comparison of baseline characteristics between the bleeding group and the non-bleeding group Table 1 exhibited the baseline demographic and clinical characteristics of the bleeding and non-bleeding group. 93 patients (69.4%) had a history of preoperative UGIB, while 41 (30.6%) did not. Statistically significant differences were observed between the two groups in terms of sex (male/female, 58/36 vs. 24/17, p=0.03), preoperative Child-Turcotte-Pugh (CTP) classification (CTP A/B, 49/45 vs. 13/28, p=0.029), and baseline HVPG (16.27±5.73 mmHg vs. 14.02±5.90 mmHg, p=0.04). Except for preoperative CTP class, baseline HVPG, sex between the two groups, the other indexes had no statistical significance (P>0.05). Furthermore, we explored the correlation between UGIB and these indicators with P＜0.05 (including preoperative CTP, sex and baseline HVPG) through ROC curve analysis. Baseline HVPG (AUROC, 0.611; 95%CI: 0.503-0.720, P=0.04) was associated with preoperative UGIB. In contrast, preoperative CTP (AUROC, 0.601; 95%CI: 0.497-0.706, P=0.062), gender (AUROC,0.398; 95%CI: 0.295-0.501, P=0.06) were not predictive. Baseline HVPG demonstrated a greater discriminative ability for a history of UGIB (Fig 1). II. Analysis of changes in HVPG before and after LSED At an average of 6 months after the surgery, the HVPG was reassessed in 57 patients. Overall, postoperative HVPG significantly decreased from baseline (mean difference: -3.57±8.09, P=0.001), equivalent to a 27.78% decrease from baseline. Further, changes in the low HVPG group (5.5 ± 7.84 mmHg, P=0.054) showed no significant difference, but these showed a significant decline in the medium HVPG group (-4.40±6.38 mmHg, P=0.001), and the high HVPG group (-7.80±7.25 mmHg, P=0.001) (Table 2). A higher baseline HVPG was associated with a more significant decrease in postoperative HVPG (Figure 2). Postoperative HVPG reduction was observed in 66.6% (38/57) of patients. Within each group, the proportions of patients experiencing a decrease in HVPG were 20% (2/10) in the low HVPG group, 78.1% (23/32) in the medium HVPG group, and 82.1% (13/15) in the high HVPG group. The group with a higher baseline HVPG had a higher proportion of patients experiencing a decrease in HVPG (p=0.001) (Figure 3). Patients in the decreased group and non-decreased group revealed statistically significant differences in baseline HVPG (18.21±5.13 mmHg vs. 13.00±4.64 mmHg, p=0.001) and preoperative CTP classification (CTP A/B, 25/13 vs. 6/13, p=0.015) (Table 3). Multivariate logistic regression analysis identified baseline HVPG (adjust OR=1.285, 95% CI:1.092-1.512, p=0.002) and preoperative CTP class B (adjust OR=0.126, 95% CI: 0.028-0.568, P=0.007) were associated with a decrease in postoperative HVPG (Table 4). Ⅲ. Survival analysis of postoperative UGIB. 57 patients with reassessed HVPG were followed postoperatively until July 31, 2023, with a mean follow-up duration of 37.14 months (37.14 ± 19.87). By the end of the follow-up period, 15.8% (9/57) of patients experienced postoperative UGIB events, but only 2 patients experienced UGIB within the first year after surgery, and the other events (7/9) occurred later than one year after surgery. One additional patient in our department experienced UGIB prior to postoperative manometry, which occurred 36 months postoperatively. Three-dimensional reconstruction of the perigastric vessels via thin-layer computed tomography (CT) revealed that a thick branch of the right gastric vein extended near the cardia (Figure 4). This vessel could be the source of postoperative UGIB. This patient subsequently underwent a surgical intervention to disconnect this aberrant perigastric vessel. Nine months following the second surgery, the HVPG was remeasured at 11 mmHg (compared to 23 mmHg at baseline). Up until now, he had not experienced UGIB. KM survival curves demonstrated that the RHFS rates for the low HVPG group were 100%, 88.9%, and 88.9% at 1, 3, and 5 years. Respectively, 93.5%, 86.6%, and 70.6% for the medium HVPG group. In the high HVPG group, the rates were 93.3% at all three time points. However, KM survival curves did not reveal a significant difference between these baseline HVPG groups (log-rank P=0.907) (Figure 5A). Patients were divided into two groups based on a postoperative HVPG cut-off of 12 mmHg. Patients with a postoperative HVPG <12 mmHg had RHFS rates of 96.0%, 92.0%, and 85.9% at 1, 3, and 5 years. In contrast, patients with a postoperative HVPG≥12mmHg showed corresponding rates of 93.3%, 85.2%, and 60.9%. However, KM survival curves also revealed no statistically significant difference between the two groups (log-rank P=0.067) (Figure 5B). However, patients were also categorized into two groups based on the magnitude of their postoperative HVPG decrease from baseline. One group included patients who experienced a decrease of more than 20% from baseline HVPG (HVPG decreased＞20%), and the other group did not (HVPG decreased≤20%). Those patients with HVPG decreased＞20% showed 1-, 3-, and 5-year RHFS rates of 96.9%, 96.9%, and 87.2%, in contrast, the rates for patients with HVPG decreased≤20% were 91.0%, 75.5%, and 62.9%, the rates were significantly different (log-rank P=0.013). (Figure 5C). By multivariate cox proportional hazards regression analysis, achieving an HVPG decreased ＞20% (adjust HR=0.08, 95% CI: 0.01-0.91, P=0.042) and a history of preoperative UGIB (adjust HR=25.92, 95% CI: 1.71-508.8, P=0.02) remained the independent prognostic factors for postoperative UGIB (Table 5). Discussion In this study, we investigated the variation pattern of HVPG in patients with PHT who received surgical treatments. Our findings demonstrated that LSED significantly reduced postoperative HVPG in patients with PHT indicating the significantly decrease of intrahepatic resistance. We also found that the variation pattern of HVPG could be applied as a more precise and quantifiable indicator of complications and prognosis in patients with PHT who underwent surgical treatments. The HVPG has been widely accepted as the gold standard for diagnosis of PHT. An HVPG ≥12 mmHg is the cut-off value for predicting a high risk of EVB. Additionally, an HVPG ≥16 mmHg is usually associated with an increased risk of developing severe complications of decompensated cirrhosis, which are difficult to reverse. Furthermore, an HVPG ≥20 mmHg is associated with a significantly increased risk of short-term mortality[8]. Many studies have demonstrated that patients with a history of UGIB have significantly higher HVPG than those without[17]. In this studied population, PHT patients with a UGIB history had a higher HVPG of 16.27 mmHg, which was consistent with the previous reports. We also found that LSED exhibited a positive impact on decreasing HVPG, meanwhile, the decline of HVPG was positively correlated with the prognosis of patients. Clinicians always try to identify markers of accurately predicting the prognosis of patients with PHT. Some widely used clinical prognostic evaluation indicators, such as the MELD score and CTP classification, had many limitations in predictive accuracy[17]. In this study, the majority of patients (91%, 123/135) had a preoperative MELD score less than 10 with a maximum of 13. All patients had CTP class A or B, indicating that most patients with decompensated cirrhosis maintained relatively normal liver metabolism and synthetic function. The significant majority of patients (77.8%, 105/135) had FIB-4 score＞3.25 indicating advanced liver cirrhosis (stages 3 and 4). No significant differences were observed in the MELD score or FIB-4 index between the bleeding group and non-bleeding groups. Moreover, HVPG demonstrated higher AUROC compared to CTP suggesting a better predictive ability for UGIB occurrence. These results indicated that HVPG was better than the MELD score, CTP classification, and FIB-4 index. The unique feature of this study lain in its repeated measurements and comparison of HVPG in the same patients over a continuous follow-up period. Our study revealed an overall downtrend in the patient cohort, demonstrating a significant reduction in postoperative HVPG compared to baseline levels. These findings were consistent with the conclusion drawn by H. Kawanaka et al. [18] Patients with a high preoperative risk of EVB(i.e. HVPG ≥12 mmHg) experienced a significantly greater decrease in postoperative HVPG than patients with a low preoperative HVPG (i.e. <12mmHg). Moreover, a higher proportion of these high-risk patients exhibited a downtrend in postoperative HVPG. Our results demonstrated that LSED effectively reduced intrahepatic resistance among patients with cirrhotic PHT, as reflected by the decrease in HVPG. This reduction may be attributed to changes in hemodynamics and histological structure. Several studies have demonstrated that splenectomy led to a significant decrease in the portal vein blood flow and altered the expression levels of vasoactive substances, including nitric oxide[18]. Microstructural-level animal experiments further demonstrated that splenectomy could effectively alleviate liver fibrosis in cirrhotic mice[19]. Additionally, Zeng et al. reported that splenectomy could significantly decrease serum fibrosis indicators among patients with cirrhosis[20]. Various pathophysiological mechanisms may be involved in this process, wherein splenectomy plays a crucial role. Specifically, it inhibits proinflammatory cytokine production and restricts inflammatory cell infiltration while promoting hepatic cell regeneration, modulating immune response, and reducing extracellular matrix deposition. These mechanisms can potentially alleviate or even reverse liver cirrhosis[21]. Our previous study also demonstrated that splenectomy could down-regulate transforming growth factor β1 (TGF-β1) production in liver macrophages. This reduction is achieved by reducing the expression of tumor necrosis factor superfamily member 14 (TNFSF14; also known as LIGHT), which ultimately attenuates liver fibrosis[22]. However, it is also important to note that the changes in HVPG were not statistically significant in patients with a baseline HVPG of 5-12 mmHg. David et al. reported that pre-treatment levels of pro-fibrotic cytokines, such as angiopoietin-2 (Ang2), were significantly lower in patients with hepatitis C cirrhosis and an HVPG≤10 mmHg compared to those with HVPG > 10 mmHg[23]. Studies have confirmed the protective effect of splenectomy on key target organs like the liver during inflammatory cytokine storm[24, 25]. Splenectomy not only relieves the pressure of the portal vein system, but also improves the immune microenvironment in the liver and alleviates the severity of cirrhosis[26-28]. For patients with low baseline HVGP (<12mmHg), the possible explanation is, that the more severe the cirrhosis, the more involved the spleen is. thus, LSED may provide a significantly protective role in those with severe liver cirrhosis. Our study revealed that a higher proportion of patients with CTP class A experienced a decrease in postoperative HVPG than those with CTP class B. This finding provided two valuable insights. Firstly, patients with cirrhosis and preserved liver function may experience improved and more continuous benefits following LSED[29]. Two potential explanations for these observations are as follows: (1) patients with CTP class B cirrhosis may have more severe cirrhosis, the total amount of effective hepatocytes may be relatively insufficient to improve intrahepatic vascular resistance, and (2) the immune microenvironment within the livers of patients with CTP class B may be significantly impaired. For example, Individuals with poor liver function (CTP class B) had lower numbers of immune cells such as Tfh17 cells[30]. Additionally, there were more substantial decreases in the responsiveness of monocytes and T cells of these patients[31]. Second, our results also highlighted the importance of implementing active preoperative interventions including strategies for liver protection, antiviral therapies, augmentation of serum albumin levels, management of coagulation disorders, and implementation of further measures to maintain stem cell status and improve liver function. These interventions may positively impact the progress of liver renovation following LSED. Following the Baveno VI consensus[13], we posited that the variation pattern of HVPG after surgery could potentially serve as a prognostic indicator for long-term outcomes. Specifically, patients who exhibited a postoperative decrease in HVPG exceeding 20% compared to baseline demonstrated a reduced risk of postoperative UGIB. Nevertheless, the survival analysis revealed no statistically significant difference in the risk of postoperative bleeding between patients with postoperative HVPG <12 mmHg and those with postoperative HVPG ≥12 mmHg. Similarly, Mattias Mandorfer et al. [32] reported that in their investigation on the impact of interferon-free therapy on the HVPG in patients with hepatitis C Virus (HCV) infection, discovering that a 20% reduction in the post-treatment HVPG from baseline was proved to be a more sensitive predictor of reduced variceal bleeding risk than achieving a post-treatment HVPG ＜12 mmHg. Approximately 57.9% (33/57) of the patients experienced a 20% decrease in their condition, indicating that LESD may yield comparable therapeutic effects to hepatitis virus eradication. Furthermore, the improvement in exhausted T-cell function after surgery may contribute to the observed clinical benefits in PHT patients. Studies have demonstrated that splenectomy can reverse the elevated expression of markers for T-cell exhaustion like PD-1 and Tim-3, on peripheral blood in PHT patients, suggesting a potential mechanism for the recovery of partial exhausted T-cells. Moreover, the heterogeneity of exhausted T-cells could be an influential factor. The diverse subpopulations of T-cells demonstrate differential capacities for functional recovery[33], suggesting that LSED may not equally enhance the function of all exhausted T-cell subsets. Thus, individual variations in exhausted T-cell subpopulations may elucidate why a minority of patients experienced a less substantial reduction in postoperative HVPG (≤20%). Of the nine patients who experienced postoperative UGIB events, only two had UGIB events within the first year after surgery. This finding provided support for the potential efficacy of LSED in treating PHT and UGIB. Eight out of the nine patients manifested as hematemesis. Upon gastroscopy, one patient was diagnosed with ulcer bleeding, while the remaining cases were attributed to varicose veins. One patient presented with melena, but no evident signs of ulcers or erythema were observed during gastroscopy. It was hypothesized that intestinal hemorrhage might be caused by PHT. In patients with cirrhosis, postoperative bleeding events indicated further disease deterioration. Variceal bleeding may be the primary cause, although portal hypertensive gastroenteropathy could also contribute significantly. All nine patients who experienced postoperative UGIB events had the history of UGIB before surgery. In contrast, no postoperative bleeding events were reported during the follow-up period in patients without a history of UGIB. Cox proportional hazards regression analysis also supported that a preoperative history of UGIB was an independent risk factor for postoperative UGIB. This finding suggests that recognizing the potential therapeutic effect of LSED is important; however, it is crucial to note that patients with a preoperative history of bleeding still face a higher risk of postoperative hemorrhage compared to those without such a history. For patients with a preoperative history of UGIB whose postoperative HVPG do not decrease significantly, treatments through gastroscopy and further reduction in portal pressure may be warranted. This study had some limitations. First, the small sample size restricted our ability to investigate the impact of various factors on changes in HVPG, such as cirrhosis etiology (e.g. autoimmune) and emerging markers like liver stiffness measurement (LSM) and spleen stiffness measurement (SSM). Second, due to the invasive nature of HVPG measurements, repeated postoperative HVPG measurements could not be accepted by all patients. In conclusion, our study addressed the gap in the application of HVPG in surgical management of PHT. We conducted a comprehensive evaluation of its prognostic value. Additionally, we observed that LSED, as a surgical intervention for PHT, effectively reduced portal pressure in cirrhotic patients with high-risk EVB (HVPG≥12mmHg). Our findings suggested the HVPG as a reliable indicator for assessing decompensation events such as EVB in patients with cirrhotic PHT. Moreover, the trend and magnitude of changes in HVPG may provide valuable prognostic information regarding long-term survival outcomes after surgical treatment in cirrhotic PHT patients. Overall, this study highlighted the critical role of HVPG in monitoring and risk assessment throughout the entire surgical treatment process for PHT patients. Therefore, we strongly recommend further promotion of the HVPG utilization in both diagnosis and treatment strategies for PHT. Abbreviations Hepatic venous pressure gradient HVPG portal hypertension PHT Laparoscopic splenectomy plus esophagogastric devascularization LSED upper gastrointestinal bleeding UGIB esophagogastric variceal bleeding EVB hepatitis B virus HBV wedged hepatic venous pressure WHVP free hepatic venous pressure FHVP model for end-stage liver disease MELD aspartate aminotransferase AST alanine aminotransferase ALT platelets PLT international normalized ratio INR fibrosis-4 FIB-4 recurrent hemorrhage-free survival RHFS receiver operating characteristic ROC area under the receiver operating characteristic AUROC confidence intervals CIs Kaplan-Meier K-M Child-Turcotte-Pugh CTP transforming growth factor β1 TGF-β1 tumor necrosis factor superfamily member 14 TNFSF14 hepatitis C virus HCV liver stiffness measurement LSM spleen stiffness measurement SSM Declarations Author Contribution Ming Zhang: Conception and design, Collection and assembly of data, Data analysis and interpretation, Writing - original draft.Dong Wang: Conception and design, Provision of study materials or patients, Writing - original draft, Funding acquisition.Xiao Chen: Collection and assembly of data, Data analysis and interpretation.Defeng Liang: Provision of study materials or patients.Tao Yang: Provision of study materials or patients.Yanlong Cao: Provision of study materials or patients.Bo Huang: Provision of study materials or patients.Jianguo Lu: Conception and design, review & editing.Jikai Yin: Conceptualization, Funding acquisition, Supervision, Writing - review & editing.Ming Zhang and Dong Wang contributed equally to this paper.Correspondence: Jikai Yin, Jianguo Lu; Department of General Surgery, the Second Affiliated Hospital of Air Force Military Medical University, 569 Xin si road, Xi’an 710038, China. 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Journal of translational medicine 2017, 15(1):111. http://doi.org/10.1186/s12967-017-1214-8 Pei Y, Chai S, Zhang Y, Zhang Z, Chen X, Zhang W: Benefits of Splenectomy and Curative Treatments for Patients with Hepatocellular Carcinoma and Portal Hypertension: a Retrospective Study. Journal of gastrointestinal surgery: official journal of the Society for Surgery of the Alimentary Tract 2019, 23(11):2151–2162. http://doi.org/10.1007/s11605-018-3981-9 Zhao S, Xu W, Xie YX, Chen WW, Zhao M: CXCR5(+) CD4(+) T cell subsets and their relationship to immune dysfunction in chronic hepatitis B-associated liver cirrhosis. Journal of gastroenterology and hepatology 2020, 35(4):689–695. http://doi.org/10.1111/jgh.14866 Al-Dury S, Waern J, Waldenström J, Alavanja M, Saed HH, Törnell A, Arabpour M, Wiktorin HG, Einarsdottir S, Ringlander J et al : Impaired SARS-CoV-2-specific T-cell reactivity in patients with cirrhosis following mRNA COVID-19 vaccination. 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Digestive diseases (Basel, Switzerland) 2017, 35(4):334–338. http://doi.org/10.1159/000456584 Tables Table 1 Baseline characteristics between bleeding and non-bleeding group All（135） Bleeding（94） Non-bleeding（41） P Age 47.34±10.97 46.21±11.26 49.93±9.93 0.07 Sex 0.03 Male 75 58 17 Female 60 36 24 Etiology 0.459 Hepatitis virus 98 70 24 Other 37 28 13 Preoperative MELD 5.33±3.42 5.00±3.45 6.14±3.23 0.064 Preoperative FIB-4 5.52(3.26,8.81) 5.27(3.26,8.81) 6.21(3.99,11.04) 0.177 Baseline HVPG 15.59±5.85 16.27±5.73 14.02±5.90 0.04 Preoperative CTP 0.029 A 62 49 13 B 73 45 28 Abbreviations: HVPG, Hepatic venous pressure gradient; FIB-4, fibrosis-4; MELD, model for end-stage liver disease; CTP, Child-Turcotte-Pugh; Table 2 Comparison of HVPG before and after surgery Baseline HVPG group n Paired Difference P N for HVPG decrease（percent） P all 57 3.57±8.09 0.001 38（66.6%） 0.001 5-12mmHg 10 -5.5±7.84 0.054 2（20%） 12-20mmHg 32 4.40±6.38 0.001 23（71.8%） ≥20mmHg 15 7.80±7.25 0.001 13（86.7%） Table 3 ：Comparison between postoperative HVPG decreased group and non-decreased group. Parameter Non-decreased group（n=19） Decreased group（n=38） P value Age 50.95±7.81 45.68±12.06 0.09 Sex 0.091 Male 7 23 Female 12 15 Etiology 0.835 Hepatitis virus 14 27 outher 5 11 History of bleeding 0.432 Yes 11 26 NO 8 12 Peroperative FIB-4 5.57(3.96,12.93) 6.21(3.45,10.95) 0.623 Peroperative MELD 5.08±4.03 5.19±3.18 0.914 Peroperative CTP 0.015 A 6 25 B 13 13 Baseline HVPG 13.00±4.64 18.21±5.13 0.001 Baseline HVPG group 0.002 low（5-12mmHg） 8 2 medium（12-20mmHg） 9 23 high（≥20mmHg） 2 13 Postoperative FIB-4 1.55(1.02,2.28) 1.27(0.84,1.99) 0.198 Postoperative MELD 0.91±4.01 1.15±3.34 0.806 Postoperative CTP 0.775 A 17 33 B 2 5 Abbreviations:HVPG, Hepatic venous pressure gradient; FIB-4, fibrosis-4; MELD, model for end-stage liver disease; CTP, Child-Turcotte-Pugh; Table 4: multivariate logistic regression analysis of the risk factors for decrease of postoperative HVPG Parameter OR 95% CI P Female 0.582 0.132-2.565 0.47 Age 0.975 0.906-1.05 0.509 Baseline HVPG(mmHg) 1.285 1.092-1.512 0.002 Preoperation CTP B 0.126 0.028-0.568 0.007 Note: Variables with P<0.10 between groups were subsequently selected for inclusion in a multivariate logistic regression . Abbreviations:HVPG, Hepatic venous pressure gradient; CTP, Child-Turcotte-Pugh; Table 5：Univariate and Multivariate Cox Regression Analyses on Determinants of (re)bleeding After LSED Univariate Analysis, n=9 Multivariate Analysis, n=9 Parameter HR（95% CI） P value aHR（95% CI） P value Baseline HVPG 1.06（0.37-3.05） 0.908 HVPG decreased＞20% 0.17（0.04-0.83） 0.029 0.08（0.01-0.91） 0.042 Postoperative HVPG ≥12 3.945（0.81-19.17） 0.089 1.28（0.15-11.22） 0.822 Female 3.166（0.649-15.441） 0.133 Age 1.064（1.001-1.133） 0.041 1.057（0.98-1.16） 0.217 Etiology（other） 0.538（0.132-2.184） 0.384 UGIB history 5.221（0.649-41.98） 0.083 29.52（1.71-508.8） 0.02 Preoperative MELD 0.839(0.67-1.06) 0.136 Preoperative FIB-4 1.07（0.93-1.22） 0.347 Preoperative CTP B 1.21（0.32-4.50） 0.780 Postoperative MELD 0.88（0.71-1.08） 0.218 Postoperative FIB-4 1.38（0.85-2.25） 0.196 Postoperative CTP B 0.040（0.00-1654.4） 0.554 Note: Variables with p < 0.10 in the univariable analysis were then incorporated into a multivariable Cox proportional hazards mode. Abbreviations: HVPG, Hepatic venous pressure gradient; FIB-4, fibrosis-4; MELD, model for end-stage liver disease; CTP, Child-Turcotte-Pugh; UGIB, upper gastrointestinal bleeding; Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4567104","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":317494914,"identity":"d9635b3f-e26f-40f5-90d1-5981a7e58904","order_by":0,"name":"Ming Zhang","email":"","orcid":"","institution":"the Second Affiliated Hospital of Air Force Military Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ming","middleName":"","lastName":"Zhang","suffix":""},{"id":317494915,"identity":"a6c26afd-8507-4a5c-b7c4-d1bd4ef0f172","order_by":1,"name":"Dong Wang","email":"","orcid":"","institution":"the Second Affiliated Hospital of Air Force Military Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Dong","middleName":"","lastName":"Wang","suffix":""},{"id":317494916,"identity":"fb013eeb-cfa5-4b7d-8200-8c0795d90a31","order_by":2,"name":"Xiao Chen","email":"","orcid":"","institution":"the Second Affiliated Hospital of Air Force Military Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xiao","middleName":"","lastName":"Chen","suffix":""},{"id":317494917,"identity":"6dd7d927-a94b-4a55-bfec-133a1e83ca92","order_by":3,"name":"Defeng Liang","email":"","orcid":"","institution":"the Second Affiliated Hospital of Air Force Military Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Defeng","middleName":"","lastName":"Liang","suffix":""},{"id":317494918,"identity":"d15577fd-9791-4ddc-98ef-42eed90db378","order_by":4,"name":"Tao Yang","email":"","orcid":"","institution":"the Second Affiliated Hospital of Air Force Military Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Tao","middleName":"","lastName":"Yang","suffix":""},{"id":317494919,"identity":"10b4b0db-ab84-4167-b0ac-dff17e503a3c","order_by":5,"name":"Yanlong Cao","email":"","orcid":"","institution":"the Second Affiliated Hospital of Air Force Military Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yanlong","middleName":"","lastName":"Cao","suffix":""},{"id":317494920,"identity":"2f60157a-4f16-43cb-a234-159e2225582e","order_by":6,"name":"Bo Huang","email":"","orcid":"","institution":"the Second Affiliated Hospital of Air Force Military Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Bo","middleName":"","lastName":"Huang","suffix":""},{"id":317494921,"identity":"d13359d9-1c38-4783-8451-52b73fc65b2d","order_by":7,"name":"Jianguo Lu","email":"","orcid":"","institution":"the Second Affiliated Hospital of Air Force Military Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jianguo","middleName":"","lastName":"Lu","suffix":""},{"id":317494922,"identity":"8f92ab27-7e9a-4c23-b4ab-a3060ee7012b","order_by":8,"name":"Jikai Yin","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0UlEQVRIiWNgGAWjYFCCBAbDBoP/cuwNYB4zYQ08YC0VzMY8B0jRwthwhjmxh2gt9uw5BoUz29jSe8ROp0kwVFgnNrCfPYDfFp43BoYb23hye6Rzt0kwnElPbODJS8CvRSLHwPBhm0TufpAWxrbDiQ0SPAbEaDFI5wFr+Ueslg1nEhIgWhqI0XLmWYHhjIoDhkC/bLZIOJZu3MaTg18Le3vyNsMegwPyQFs23vhQYy3bz34GvxYGBg4zhIoEIGYjoB5kz+MHhBWNglEwCkbBiAYAMBpDWFKdHWkAAAAASUVORK5CYII=","orcid":"","institution":"the Second Affiliated Hospital of Air Force Military Medical University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Jikai","middleName":"","lastName":"Yin","suffix":""}],"badges":[],"createdAt":"2024-06-12 03:08:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4567104/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4567104/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60184193,"identity":"10136c1d-911a-4f11-a42f-339846cbd1e2","added_by":"auto","created_at":"2024-07-12 18:36:01","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":11123,"visible":true,"origin":"","legend":"\u003cp\u003eReceiver operating characteristic curves of HVPG, sex, CTP predicting varicose bleeding(AUROC of HVPG: 0.611, 95%CI: 0.503-0.720, P=0.04; AUROC of sex: 0.601, 95%CI:0.497-0.706, P=0.062; AUROC of CTP:0.398,95%CI: 0.295-0.501, P=0.06)\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4567104/v1/01fc542b7a6684f5b3fffe4d.jpg"},{"id":60185848,"identity":"58671ad3-ea1a-46dd-b972-c9b1615107c4","added_by":"auto","created_at":"2024-07-12 18:44:01","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":19252,"visible":true,"origin":"","legend":"\u003cp\u003eAverage decline value in different baseline \u0026nbsp;\u0026nbsp;HVPG groups.\u003c/p\u003e\n\u003cp\u003e（low HVPG group：-5.5 ± 7.84 mmHg; medium HVPG group: 4.40±6.38 mmHg; the high HVPG group:7.80±7.25 mmHg. ）\u003c/p\u003e","description":"","filename":"Picture2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4567104/v1/bc76c97fbcc78a44be72a930.jpg"},{"id":60184191,"identity":"8e2d1d29-d006-44a9-b000-d781c1b91e13","added_by":"auto","created_at":"2024-07-12 18:36:01","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":22672,"visible":true,"origin":"","legend":"\u003cp\u003eThe proportion of patients with a decreased postoperative HVPG in different baseline HVPG groups\u003c/p\u003e","description":"","filename":"Picture3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4567104/v1/34081f0f4dd172f89fc2ac08.jpg"},{"id":60186377,"identity":"dea0c05c-d5f1-44a6-b282-d6c81e7ebf85","added_by":"auto","created_at":"2024-07-12 18:52:01","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":58591,"visible":true,"origin":"","legend":"\u003cp\u003eThree-dimensional reconstruction of portal system after LSED\u003c/p\u003e","description":"","filename":"Picture4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4567104/v1/8e667bce0130643d3b49eba5.jpg"},{"id":60186379,"identity":"83891f61-2c10-45f3-8a21-9c50137921b6","added_by":"auto","created_at":"2024-07-12 18:52:01","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":79469,"visible":true,"origin":"","legend":"\u003cp\u003eKM plot for (RHFS) rate after LSED .(5A) according to HVPG categories at baseline. (5B) according to postoperative HVPG. (5C) according to postoperative HVPG decrease＞20% from baseline or not.\u003c/p\u003e","description":"","filename":"Picture5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4567104/v1/2af40e665a451f69784094e4.jpg"},{"id":61443594,"identity":"3a9ec983-c912-4166-a58f-bbe4cd8ae4dc","added_by":"auto","created_at":"2024-07-30 21:16:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":811511,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4567104/v1/25be5595-305b-4d47-9b56-bd512e6d0d32.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The independent prognostic value of Perioperative HVPG measurements in patients with portal hypertension and received Laparoscopic splenectomy plus esophagogastric devascularization","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePortal hypertension (PHT) is a complicated clinical syndrome along with end-stage cirrhosis, which is always caused by the hepatitis B virus (HBV) infection in China. PHT-related complications\u0026nbsp;and\u0026nbsp;symptoms include ascites, hepatic encephalopathy, esophagogastric variceal bleeding (EVB)[1]. Once EVB occurs, the mortality rate of the first bleeding episode is 25%-30%, and the rebleeding rate is 60% if left untreated[2].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe Baveno VII consensus emphasized the hepatic venous pressure gradient (HVPG) as a gold standard to evaluate\u0026nbsp;the\u0026nbsp;presence\u0026nbsp;and\u0026nbsp;severity\u0026nbsp;of\u0026nbsp;PHT[3].\u0026nbsp;The risk of EVB\u0026nbsp;significantly increases as\u0026nbsp;HVPG\u0026nbsp;increases[4]. Many studies have shown that a sustained reduction in HVPG following treatment is associated with improved clinical outcomes; therefore, a significant decrease in HVPG is considered the most reliable indicator for assessing the efficacy of medical interventions in the management of PHT[5-7].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTherapies for EVB include conservative treatments, endoscopic\u0026nbsp;therapy,\u0026nbsp;interventional therapy and surgical treatment. In China, due to the lack of liver donors, splenectomy plus esophagogastric devascularization has been widely accepted and applied for decades. Considering the high risk of this surgical procedure, LSED was usually recommended for patients with a history of upper gastrointestinal bleeding (UGIB) and/or with a high HVPG (\u0026gt;12 mmHg), and this surgery was also recommended for individuals who did not respond to non-surgical treatments but still had acceptable hepatic reserved function[8]. Along with the rapid development of laparoscopic techniques worldwide, LSED has become a conventional operation with accurate preoperative planning and meticulous intraoperative operations[9]. LSED could effectively alleviate\u0026nbsp;hypersplenism and prevent recurrent EVB in patients with cirrhosis[10, 11].\u003c/p\u003e\n\u003cp\u003eUntil now, to our knowledge, the variation pattern of HVPG accompanied by surgical interventions has not yet been well studied; moreover, the prognosis value of HVPG for perioperative use also needs to be further illustrated. This study aimed to initially reveal the variation pattern of HVPG in the perioperative period of LSED and its potential prognosis value on clinical outcomes in PHT patients received surgical interventions.\u003c/p\u003e"},{"header":"Patients And Methods","content":"\u003cp\u003e\u003cstrong\u003ePatients\u003c/strong\u003e:\u0026nbsp;From January 2016 to March 2023, we enrolled patients who were diagnosed with cirrhotic PHT, and received LSED at\u0026nbsp;the Department of General Surgery, the Second Affiliated Hospital of Air Force Military Medical University. This retrospective study only involved patients whose preoperative information was complete. In total, 134 patients were enrolled and divided into two groups according to the\u0026nbsp;preoperative\u0026nbsp;UGIB history.\u0026nbsp;Among the studied population, 57 patients received repeated HVPG measurements in follow-up. The study protocol was approved by the local ethics committee, and informed consent was obtained from each patient.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion and exclusion criteria\u003c/strong\u003e. Inclusion criteria: (1) the patients with cirrhotic PHT were diagnosed according to clinical characteristics, laboratory tests, imaging, and/or histologic criteria; (2) HVPG measurements were performed for each patient, and a baseline HVPG\u0026nbsp;＞\u0026nbsp;5 mmHg was consistent with the diagnosis of PHT; (3) LSED was performed by a same surgical team; (4) complete follow-up data were available at the hospital.\u003c/p\u003e\n\u003cp\u003eExclusion criteria:(1)\u0026nbsp;the measurement results of HVPG were inaccurate due to small shunt among hepatic veins; (2) non-cirrhotic cause of PHT; (3) concomitant malignancy; (4) hematological diseases and splenic tumors pathologically diagnosed by bone marrow biopsy or (and) spleen resection; (5) history of transjugular intrahepatic portosystemic shunt or liver surgery; (6) concomitant severe cardio-pulmonary disease and renal failure. (6) with age less than 18 years old or over 75 years old; (7) refused to follow clinical recommendations or lost in follow-up.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurgical methods:\u003c/strong\u003e the LSED procedure was performed according to a standardized operating procedure as we mentioned before[12]. In brief, we applied five trocars for LSED. After dissecting the gastrocolonic ligament, the splenic artery was separated and ligated initially. The spleen volume was decreased following that, to ensure the safer splenectomy procedure. The spleen was transected with an Endo GIA\u003csup\u003eTM\u003c/sup\u003e stapler after the dissection of the splenic ligaments. The left gastric vein was cut at root with an Endo GIA\u003csup\u003eTM\u003c/sup\u003e stapler. The varices along the stomach and abdominal segment of esophagus were cut off. For varicose right gastric vein, we tended to handle it together during the surgery. Then put the spleen into the specimen bag in the abdominal cavity, fragmented and removed through a 2 to 3-cm incision.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHVPG measurements\u003c/strong\u003e: HVPG was measured at the same hospital according to a standardized operating procedure[13]. HVPG measurements were performed with a 7-French balloon catheter (Pejcl Medizintechnik). Specifically, under local anesthesia (lidocaine) and\u0026nbsp;ultrasound\u0026nbsp;guidance, a venous introducer was placed in the right internal jugular vein using the Seldinger technique. A balloon catheter was introduced into the middle hepatic vein or right vein under fluoroscopic guidance, then adequate occlusion of the hepatic vein was confirmed by the absence of backflow and shunt following dye injection.\u0026nbsp;The wedged hepatic venous pressure (WHVP) and free hepatic venous pressure (FHVP) were measured three times in these positions. The HVPG was calculated as the mean difference between three measurements of WHVP and FHVP.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePatients were classified according to clinically relevant HVPG cut-off values. (1) Patients were stratified into three groups according to baseline HVPG: the low HVPG group (baseline HVPG＜12 mmHg), the medium HVPG group (baseline HVPG \u0026ge;12 mmHg and\u0026nbsp;＜20 mmHg), and the high HVPG group (HVPG\u0026ge;20 mmHg). They were associated with a lower risk of EVB, higher risk of EVB, and significantly higher risk of death, respectively[8]. (2) Significant changes in the postoperative HVPG were defined as a decrease of \u0026ge;20% from baseline HVPG, as recommended by the Baveno VI consensus[14]. (3) Patients were divided into two groups again based on their postoperative HVPG: the decreased group, including patients showing a reduction in postoperative HVPG from baseline, and the non-decreased group, including patients who did not.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFollow-up\u003c/strong\u003e: The following clinical data before\u0026nbsp;and\u0026nbsp;after\u0026nbsp;surgery\u0026nbsp;were\u0026nbsp;collected\u0026nbsp;for all patients: (1) basic information, including sex, age, cause of cirrhosis, and bleeding history; (2) laboratory test results, including aspartate aminotransferase (AST) level, alanine aminotransferase (ALT) level, platelets (PLT) levels, albumin levels, international normalized ratio (INR), total bilirubin levels, HVPG, and creatinine levels. (3) Imaging assessment: ultrasonography was applied to detect the presence and quantify the volume of ascites. (4) The fibrosis-4 (FIB-4) index was calculated according to the following formula: FIB-4 = age (years)\u0026times; AST (IU/L)/[PLT(10\u003csup\u003e9\u003c/sup\u003e/L) \u0026times; ALT\u003csup\u003e\u0026frac12;\u003c/sup\u003e(IU/L)][15]. The model for end-stage liver disease (MELD) scores were calculated with the following equation: MELD =9.57\u0026times;ln [creatinine (mg/dl)]+3.78\u0026times;ln[bilirubin (mg/dl)] + 11.2\u0026times;ln(INR) + 6.43 \u0026times; Etiology (0 for cholestatic and alcoholic cirrhosis, 1 for other causes such as viral cirrhosis)[16]. (6) the follow-up duration was calculated as the time from surgery to one of the following events, whichever occurred first: last follow-up, UGIB, death due to UGIB, or loss to follow-up. The last follow-up date for this study was July 31, 2023. (7) the primary endpoint was recurrent hemorrhage-free survival (RHFS), which was defined as the time from surgery to the first postoperative UGIB[12].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e: Continuous variables with a normal distribution are expressed as the`mean \u0026plusmn; standard deviation. Continuous variables with a non-normal distribution were expressed as medians (interquartile ranges: Q1, Q3). Continuous variables were compared between groups using either Student\u0026rsquo; s t test for normally distributed data or the Mann-Whitney U test for non-normally distributed data, as assessed by appropriate normality tests. Categorical variables were compared with chi-square or Fisher\u0026rsquo;s exact tests. Receiver operating characteristic (ROC) curve analysis was used to test the discriminatory power of UGIB. And the area under the ROC curve (AUROC), along with its 95% confidence intervals (CIs), was calculated. Variables with P\u0026lt;0.10 between groups were subsequently selected for inclusion in a multivariate logistic regression analysis. RHFS-rates were analyzed by the Kaplan-Meier (K-M) method and compared by the log-rank test. Univariate cox proportional hazards models were employed to assess the associations between baseline variables and postoperative UGIB events. Variables with p \u0026lt; 0.10 in the univariable analysis were then incorporated into a multivariable cox proportional hazards model to identify independent prognostic factors. P＜0.05 was considered to indicate statistical significance. The analysis was performed with IBM SPSS Statistics for Windows, Version 27.0 (IBM Corp, Armonk, NY).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eⅠ. Comparison of baseline characteristics between the bleeding group and the non-bleeding group\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 1 exhibited the baseline demographic and clinical characteristics of the bleeding and non-bleeding group. 93 patients (69.4%) had a history of preoperative UGIB, while 41 (30.6%) did not. Statistically significant differences were observed between the two groups in terms of sex (male/female, 58/36 vs. 24/17, p=0.03), preoperative\u0026nbsp;Child-Turcotte-Pugh (CTP) classification\u0026nbsp;(CTP A/B, 49/45 vs. 13/28, p=0.029), and baseline HVPG (16.27\u0026plusmn;5.73 mmHg vs. 14.02\u0026plusmn;5.90 mmHg,\u0026nbsp;p=0.04). Except for preoperative CTP class, baseline HVPG, sex between the two groups, the other indexes had no statistical significance (P\u0026gt;0.05).\u003c/p\u003e\n\u003cp\u003eFurthermore, we explored the correlation between UGIB and these indicators with P＜0.05 (including preoperative CTP, sex and baseline HVPG) through ROC\u0026nbsp;curve\u0026nbsp;analysis. Baseline HVPG (AUROC, 0.611; 95%CI: 0.503-0.720, P=0.04) was associated with preoperative UGIB. In contrast, preoperative CTP (AUROC, 0.601; 95%CI: 0.497-0.706, P=0.062), gender (AUROC,0.398; 95%CI: 0.295-0.501, P=0.06) were not predictive. Baseline HVPG demonstrated a greater discriminative ability for a history of UGIB (Fig 1).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eII. Analysis of changes in HVPG before and after LSED\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAt\u0026nbsp;an\u0026nbsp;average\u0026nbsp;of 6 months after the surgery, the HVPG was reassessed in 57 patients. Overall, postoperative HVPG significantly decreased from baseline (mean difference: -3.57\u0026plusmn;8.09, P=0.001), equivalent\u0026nbsp;to a 27.78%\u0026nbsp;decrease\u0026nbsp;from\u0026nbsp;baseline. Further, changes\u0026nbsp;in the low HVPG group (5.5 \u0026plusmn; 7.84 mmHg, P=0.054)\u0026nbsp;showed\u0026nbsp;no\u0026nbsp;significant\u0026nbsp;difference, but these showed a\u0026nbsp;significant\u0026nbsp;decline in the medium HVPG group (-4.40\u0026plusmn;6.38 mmHg, P=0.001), and the high HVPG group (-7.80\u0026plusmn;7.25 mmHg, P=0.001) (Table 2). A higher baseline HVPG was associated with a more significant decrease in postoperative HVPG (Figure 2). Postoperative HVPG reduction was observed in 66.6% (38/57) of patients. Within each group, the proportions of patients experiencing a decrease in HVPG were 20% (2/10) in the low HVPG group, 78.1% (23/32) in the medium HVPG group, and 82.1% (13/15) in the high HVPG group. The group with a higher baseline HVPG had a\u0026nbsp;higher\u0026nbsp;proportion\u0026nbsp;of\u0026nbsp;patients experiencing a decrease in HVPG\u0026nbsp;(p=0.001) (Figure 3).\u003c/p\u003e\n\u003cp\u003ePatients in the decreased group and non-decreased group revealed statistically significant differences in baseline HVPG (18.21\u0026plusmn;5.13 mmHg vs. 13.00\u0026plusmn;4.64 mmHg,\u0026nbsp;p=0.001) and preoperative CTP classification (CTP A/B, 25/13 vs. 6/13, p=0.015) (Table 3). Multivariate logistic regression analysis identified baseline HVPG (adjust OR=1.285, 95% CI:1.092-1.512, p=0.002) and preoperative CTP class B (adjust OR=0.126, 95% CI: 0.028-0.568, P=0.007) were associated with a decrease in postoperative HVPG (Table 4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eⅢ. Survival analysis of postoperative UGIB.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e57\u0026nbsp;patients with reassessed HVPG were followed postoperatively until July 31, 2023, with a mean follow-up duration of 37.14 months (37.14 \u0026plusmn; 19.87). By the end of the follow-up period, 15.8% (9/57) of patients experienced postoperative UGIB events, but only 2 patients experienced UGIB within the first year after surgery, and the other events (7/9) occurred later than one year after surgery.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOne additional patient in our department experienced UGIB prior to postoperative manometry, which occurred 36 months postoperatively. Three-dimensional reconstruction of the perigastric vessels via thin-layer computed tomography (CT) revealed that a thick branch of the right gastric vein extended near the cardia (Figure 4). This vessel could be the source of postoperative UGIB. This patient subsequently underwent a surgical intervention to disconnect this aberrant perigastric vessel. Nine months following the second surgery, the HVPG was remeasured at 11 mmHg (compared to 23 mmHg at baseline). Up\u0026nbsp;until\u0026nbsp;now, he had not experienced UGIB.\u003c/p\u003e\n\u003cp\u003eKM\u0026nbsp;survival\u0026nbsp;curves demonstrated that the RHFS rates for the low HVPG group were 100%, 88.9%, and 88.9% at 1, 3, and 5 years. Respectively, 93.5%, 86.6%, and 70.6% for the medium HVPG group. In the high HVPG group, the rates were 93.3% at all three time points. However, KM\u0026nbsp;survival\u0026nbsp;curves did not reveal a significant difference between these baseline HVPG groups (log-rank P=0.907) (Figure 5A). Patients were divided into two groups based on a postoperative HVPG cut-off of 12 mmHg. Patients with a postoperative HVPG \u0026lt;12 mmHg had RHFS rates of 96.0%, 92.0%, and 85.9% at 1, 3, and 5 years. In contrast, patients with a postoperative HVPG\u0026ge;12mmHg showed corresponding rates of 93.3%, 85.2%, and 60.9%. However, KM\u0026nbsp;survival\u0026nbsp;curves also revealed no statistically significant difference between the two groups (log-rank P=0.067) (Figure 5B). However, patients were also categorized into two groups based on the magnitude of their postoperative HVPG decrease from baseline. One group included patients who experienced a decrease of more than 20% from baseline HVPG (HVPG decreased＞20%), and the other group did not (HVPG decreased\u0026le;20%). Those patients with HVPG decreased＞20% showed 1-, 3-, and 5-year RHFS rates of 96.9%, 96.9%, and 87.2%, in contrast, the rates for patients with HVPG decreased\u0026le;20% were 91.0%, 75.5%, and 62.9%, the rates\u0026nbsp;were significantly different\u0026nbsp;(log-rank P=0.013). (Figure 5C).\u003c/p\u003e\n\u003cp\u003eBy multivariate cox proportional hazards regression analysis, achieving an HVPG decreased ＞20% (adjust HR=0.08, 95% CI: 0.01-0.91, P=0.042) and a history of preoperative UGIB (adjust HR=25.92, 95% CI: 1.71-508.8, P=0.02) remained the independent prognostic factors for postoperative UGIB (Table 5).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we investigated the variation pattern of HVPG in patients with PHT who received surgical treatments. Our findings demonstrated that LSED significantly reduced postoperative HVPG in patients with PHT indicating the significantly decrease of intrahepatic\u0026nbsp;resistance. We also found that the variation pattern of HVPG could be applied as a more precise and quantifiable indicator of complications and prognosis in patients with PHT who underwent surgical treatments.\u003c/p\u003e\n\u003cp\u003eThe HVPG has been widely accepted as the gold standard for diagnosis of PHT. An HVPG \u0026ge;12 mmHg is the cut-off value for predicting a high risk of EVB. Additionally, an HVPG \u0026ge;16 mmHg is usually associated with an increased risk of developing severe complications of decompensated cirrhosis, which are difficult to reverse. Furthermore, an HVPG \u0026ge;20 mmHg is associated with a significantly increased risk of short-term mortality[8]. Many studies have demonstrated that patients with a history of UGIB have significantly higher HVPG than those without[17]. In this studied population, PHT patients with a UGIB history had a higher HVPG of 16.27 mmHg, which was consistent with the previous reports. We also found that LSED exhibited a positive impact on decreasing HVPG, meanwhile, the decline of HVPG was positively correlated with the prognosis of patients.\u003c/p\u003e\n\u003cp\u003eClinicians always try to identify markers of accurately predicting the prognosis of patients with PHT. Some widely used clinical prognostic evaluation indicators, such as the MELD score and CTP classification, had many limitations in predictive accuracy[17]. In this study, the majority of patients (91%, 123/135) had a preoperative MELD score less than 10 with a maximum of 13. All patients had CTP class A or B, indicating that most patients with decompensated cirrhosis maintained relatively normal liver metabolism and synthetic function. The significant majority of patients (77.8%, 105/135) had FIB-4 score＞3.25 indicating advanced liver cirrhosis (stages 3 and 4). No significant differences were observed in the MELD score or FIB-4 index between the bleeding group and non-bleeding groups. Moreover, HVPG demonstrated higher AUROC compared to CTP suggesting a better predictive ability for UGIB occurrence. These results indicated that HVPG was better than the MELD score, CTP classification, and FIB-4 index.\u003c/p\u003e\n\u003cp\u003eThe unique feature of this study lain in its repeated measurements and comparison of HVPG in the same patients over a continuous follow-up period. Our study revealed an overall downtrend in the patient cohort, demonstrating a significant reduction in postoperative HVPG compared to baseline levels. These findings were consistent with the conclusion drawn by \u003cem\u003eH. Kawanaka et al.\u003c/em\u003e[18]\u0026nbsp;Patients with a high preoperative risk of EVB(i.e. HVPG\u0026nbsp;\u0026ge;12 mmHg) experienced a significantly greater decrease in postoperative HVPG than patients with a low preoperative HVPG (i.e. \u0026lt;12mmHg). Moreover, a higher proportion of these high-risk patients exhibited a downtrend in postoperative HVPG. Our results demonstrated that LSED effectively reduced intrahepatic resistance among patients with cirrhotic PHT, as reflected by the decrease in HVPG. This reduction may be attributed to changes in hemodynamics and histological\u0026nbsp;structure. Several studies have demonstrated that splenectomy led to a significant decrease in the portal vein blood flow and altered the expression levels of vasoactive substances, including nitric oxide[18]. Microstructural-level animal experiments further demonstrated that splenectomy could effectively alleviate\u0026nbsp;liver\u0026nbsp;fibrosis in cirrhotic mice[19]. Additionally, \u003cem\u003eZeng\u003c/em\u003e \u003cem\u003eet al.\u0026nbsp;\u003c/em\u003ereported that splenectomy could significantly decrease serum fibrosis indicators among patients with cirrhosis[20]. Various pathophysiological mechanisms may be involved in this process, wherein splenectomy plays a crucial role. Specifically, it inhibits proinflammatory cytokine production and restricts inflammatory cell infiltration while promoting hepatic cell regeneration, modulating immune response, and reducing extracellular matrix deposition. These mechanisms can potentially alleviate or even reverse liver cirrhosis[21]. Our previous study also demonstrated that splenectomy could down-regulate transforming growth factor \u0026beta;1 (TGF-\u0026beta;1) production in liver macrophages. This reduction is achieved by reducing the expression of tumor necrosis factor superfamily member 14 (TNFSF14; also known as LIGHT), which ultimately attenuates liver fibrosis[22].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHowever, it is also important to note that the changes in HVPG were not statistically significant in patients with a baseline HVPG of 5-12 mmHg. \u003cem\u003eDavid\u003c/em\u003e \u003cem\u003eet al.\u0026nbsp;\u003c/em\u003ereported that pre-treatment levels of pro-fibrotic cytokines, such as angiopoietin-2 (Ang2), were significantly lower in patients with hepatitis C cirrhosis and an HVPG\u0026le;10 mmHg compared to those with HVPG \u0026gt; 10 mmHg[23]. Studies have confirmed the protective effect of splenectomy on key target organs like the liver during inflammatory cytokine storm[24, 25]. Splenectomy not only relieves the pressure of the portal vein system, but also improves the immune microenvironment in the liver and alleviates the severity of cirrhosis[26-28]. For patients with low baseline HVGP (\u0026lt;12mmHg), the possible explanation is, that\u0026nbsp;the more severe the cirrhosis, the more involved the spleen is. thus, LSED may provide a significantly protective role in those with severe liver cirrhosis.\u003c/p\u003e\n\u003cp\u003eOur study revealed that a higher proportion of patients with CTP class A experienced a decrease in postoperative HVPG than those with CTP class B. This finding provided two valuable insights. Firstly, patients with cirrhosis and preserved liver function may experience improved and more continuous benefits following LSED[29]. Two potential explanations for these observations are as follows: (1) patients with CTP class B cirrhosis may have more severe cirrhosis,\u0026nbsp;the total amount of effective hepatocytes may be relatively insufficient to improve intrahepatic vascular resistance, and (2) the immune microenvironment within the livers of patients with CTP class B may be significantly impaired. For example, Individuals with poor liver function (CTP class B) had lower numbers of immune cells such as Tfh17 cells[30]. Additionally, there were more substantial decreases in the responsiveness of monocytes and T cells of these patients[31]. Second, our results also highlighted the importance of implementing active preoperative interventions including strategies for liver protection, antiviral therapies, augmentation of serum albumin levels, management of coagulation disorders, and implementation of further measures to maintain stem cell status and improve liver function. These interventions may positively impact the progress of liver renovation following LSED.\u003c/p\u003e\n\u003cp\u003eFollowing the Baveno VI consensus[13], we posited that the variation pattern of HVPG after surgery could potentially serve as a prognostic indicator for long-term outcomes. Specifically, patients who exhibited a postoperative decrease in HVPG exceeding 20% compared to baseline demonstrated a reduced risk of postoperative UGIB. Nevertheless, the survival analysis revealed no statistically significant difference in the risk of postoperative bleeding between patients with postoperative HVPG \u0026lt;12 mmHg and those with postoperative HVPG\u0026nbsp;\u0026ge;12 mmHg. Similarly, \u003cem\u003eMattias Mandorfer\u003c/em\u003e \u003cem\u003eet al.\u003c/em\u003e[32]\u0026nbsp;reported that in their investigation on the impact of interferon-free therapy on the HVPG in patients with hepatitis C Virus (HCV) infection, discovering that a 20% reduction in the post-treatment HVPG from baseline was proved to be a more sensitive predictor of reduced variceal bleeding risk than achieving a post-treatment HVPG\u0026nbsp;＜12 mmHg. Approximately 57.9% (33/57) of the patients experienced a 20% decrease in their condition, indicating that LESD may yield comparable therapeutic effects to hepatitis virus eradication. Furthermore, the improvement in exhausted T-cell function after surgery may contribute to the observed clinical benefits in PHT patients. Studies have demonstrated that splenectomy can reverse the elevated expression of markers for T-cell exhaustion like PD-1 and Tim-3, on peripheral blood in PHT patients, suggesting a potential mechanism for the recovery of partial exhausted T-cells. Moreover, the heterogeneity of exhausted T-cells could be an influential factor. The diverse subpopulations of T-cells demonstrate differential capacities for functional recovery[33], suggesting that LSED may not equally enhance the function of all exhausted T-cell subsets. Thus, individual variations in exhausted T-cell subpopulations may elucidate why a minority of patients experienced a less substantial reduction in postoperative HVPG (\u0026le;20%).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; Of the nine patients who experienced postoperative UGIB events, only two had UGIB events within the first year after surgery. This finding provided support for the potential efficacy of LSED in treating PHT and UGIB. Eight out of the nine patients manifested as hematemesis. Upon gastroscopy, one patient was diagnosed with ulcer bleeding, while the remaining cases were attributed to varicose veins. One patient presented with melena, but no evident signs of ulcers or erythema were observed during gastroscopy. It was hypothesized that intestinal hemorrhage might be caused by PHT. In patients with cirrhosis, postoperative bleeding events indicated further disease deterioration. Variceal bleeding may be the primary cause, although portal hypertensive gastroenteropathy could also contribute significantly. All nine patients who experienced postoperative UGIB events had the history of UGIB before surgery. In contrast, no postoperative bleeding events were reported during the follow-up period in patients without a history of UGIB. Cox proportional hazards regression analysis also supported that a preoperative history of UGIB was an independent risk factor for postoperative UGIB. This finding suggests that recognizing the potential therapeutic effect of LSED is important; however, it is crucial to note that patients with a preoperative history of bleeding still face a higher risk of postoperative hemorrhage compared to those without such a history. For patients with a preoperative history of UGIB whose postoperative HVPG do not decrease significantly, treatments through gastroscopy and further reduction in portal pressure may be warranted.\u003c/p\u003e\n\u003cp\u003eThis study had some limitations. First, the small sample size restricted our ability to investigate the impact of various factors on changes in HVPG, such as cirrhosis etiology (e.g. autoimmune) and emerging markers like liver stiffness measurement (LSM) and spleen stiffness measurement (SSM). Second, due to the invasive nature of HVPG measurements, repeated postoperative HVPG measurements could not be accepted by all patients.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn conclusion, our study addressed the gap in the application of HVPG in surgical management of PHT. We conducted a comprehensive evaluation of its prognostic value. Additionally, we observed that LSED, as a surgical intervention for PHT, effectively reduced portal pressure in cirrhotic patients with high-risk EVB (HVPG\u0026ge;12mmHg). Our findings suggested the HVPG as a reliable indicator for assessing decompensation events such as EVB in patients with cirrhotic PHT. Moreover, the trend and magnitude of changes in HVPG may provide valuable prognostic information regarding long-term survival outcomes after surgical treatment in cirrhotic PHT patients. Overall, this study highlighted the critical role of HVPG in monitoring and risk assessment throughout the entire surgical treatment process for PHT patients. Therefore, we strongly recommend further promotion of the HVPG utilization in both diagnosis and treatment strategies for PHT.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHepatic venous pressure gradient\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHVPG\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eportal hypertension\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePHT\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLaparoscopic splenectomy plus esophagogastric devascularization\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLSED\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eupper gastrointestinal bleeding\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUGIB\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eesophagogastric variceal bleeding\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEVB\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ehepatitis B virus\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHBV\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ewedged hepatic venous pressure\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWHVP\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003efree hepatic venous pressure\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFHVP\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003emodel for end-stage liver disease\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMELD\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003easpartate aminotransferase\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAST\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ealanine aminotransferase\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eALT\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eplatelets\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePLT\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003einternational normalized ratio\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eINR\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003efibrosis-4\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFIB-4\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003erecurrent hemorrhage-free survival\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRHFS\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ereceiver operating characteristic\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eROC\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003earea under the receiver operating characteristic\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAUROC\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003econfidence intervals\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCIs\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eKaplan-Meier\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eK-M\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eChild-Turcotte-Pugh\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCTP\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003etransforming growth factor β1\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTGF-β1\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003etumor necrosis factor superfamily member 14\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTNFSF14\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ehepatitis C virus\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHCV\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eliver stiffness measurement\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLSM\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003espleen stiffness measurement\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSSM\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eMing Zhang: Conception and design, Collection and assembly of data, Data analysis and interpretation, Writing - original draft.Dong Wang: Conception and design, Provision of study materials or patients, Writing - original draft, Funding acquisition.Xiao Chen: Collection and assembly of data, Data analysis and interpretation.Defeng Liang: Provision of study materials or patients.Tao Yang: Provision of study materials or patients.Yanlong Cao: Provision of study materials or patients.Bo Huang: Provision of study materials or patients.Jianguo Lu: Conception and design, review \u0026amp; editing.Jikai Yin: Conceptualization, Funding acquisition, Supervision, Writing - review \u0026amp; editing.Ming Zhang and Dong Wang contributed equally to this paper.Correspondence: Jikai Yin, Jianguo Lu; Department of General Surgery, the Second Affiliated Hospital of Air Force Military Medical University, 569 Xin si road, Xi\u0026rsquo;an 710038, China. Email: [email protected]; [email protected]. All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eDATA AVAILABILITY STATEMENT\u003c/h2\u003e \u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWang X, Lin SX, Tao J, Wei XQ, Liu YT, Chen YM, Wu B: Study of liver cirrhosis over ten consecutive years in Southern China. 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Digestive diseases (Basel, Switzerland) 2017, 35(4):334\u0026ndash;338.\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.1159/000456584\u003c/span\u003e\u003cspan address=\"10.1159/000456584\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 \u0026nbsp;Baseline characteristics between bleeding and non-bleeding group\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"611\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.856209150326798%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.058823529411764%\"\u003e\n \u003cp\u003eAll（135）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.58823529411765%\"\u003e\n \u003cp\u003eBleeding（94）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003eNon-bleeding（41）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.49673202614379%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.856209150326798%\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.058823529411764%\"\u003e\n \u003cp\u003e47.34\u0026plusmn;10.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.58823529411765%\"\u003e\n \u003cp\u003e46.21\u0026plusmn;11.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e49.93\u0026plusmn;9.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.49673202614379%\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.856209150326798%\"\u003e\n \u003cp\u003eSex\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.058823529411764%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.58823529411765%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.49673202614379%\"\u003e\n \u003cp\u003e\u003cem\u003e0.03\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.856209150326798%\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.058823529411764%\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.58823529411765%\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.49673202614379%\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.856209150326798%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.058823529411764%\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.58823529411765%\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.49673202614379%\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.856209150326798%\"\u003e\n \u003cp\u003eEtiology\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.058823529411764%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.58823529411765%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.49673202614379%\"\u003e\n \u003cp\u003e0.459\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.856209150326798%\"\u003e\n \u003cp\u003eHepatitis virus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.058823529411764%\"\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.58823529411765%\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.49673202614379%\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.856209150326798%\"\u003e\n \u003cp\u003e\u0026nbsp;Other\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.058823529411764%\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.58823529411765%\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.49673202614379%\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.856209150326798%\"\u003e\n \u003cp\u003ePreoperative MELD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.058823529411764%\"\u003e\n \u003cp\u003e5.33\u0026plusmn;3.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.58823529411765%\"\u003e\n \u003cp\u003e5.00\u0026plusmn;3.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e6.14\u0026plusmn;3.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.49673202614379%\"\u003e\n \u003cp\u003e0.064\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.856209150326798%\"\u003e\n \u003cp\u003ePreoperative FIB-4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.058823529411764%\"\u003e\n \u003cp\u003e5.52(3.26,8.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.58823529411765%\"\u003e\n \u003cp\u003e5.27(3.26,8.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e6.21(3.99,11.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.49673202614379%\"\u003e\n \u003cp\u003e0.177\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.856209150326798%\"\u003e\n \u003cp\u003eBaseline HVPG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.058823529411764%\"\u003e\n \u003cp\u003e15.59\u0026plusmn;5.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.58823529411765%\"\u003e\n \u003cp\u003e16.27\u0026plusmn;5.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e14.02\u0026plusmn;5.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.49673202614379%\"\u003e\n \u003cp\u003e\u003cem\u003e0.04\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.856209150326798%\"\u003e\n \u003cp\u003ePreoperative CTP \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.058823529411764%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.58823529411765%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.49673202614379%\"\u003e\n \u003cp\u003e\u003cem\u003e0.029\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.856209150326798%\"\u003e\n \u003cp\u003eA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.058823529411764%\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.58823529411765%\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.49673202614379%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.856209150326798%\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.058823529411764%\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.58823529411765%\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.49673202614379%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: HVPG, Hepatic venous pressure gradient; FIB-4, fibrosis-4; MELD, model for end-stage liver disease; CTP, Child-Turcotte-Pugh;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"643\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"6\"\u003e\n \u003cp\u003e\u0026nbsp;Table 2 \u0026nbsp;Comparison of HVPG before and after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.32398753894081%\"\u003e\n \u003cp\u003eBaseline HVPG group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.165109034267913%\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.757009345794394%\"\u003e\n \u003cp\u003ePaired Difference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.411214953271028%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.414330218068535%\"\u003e\n \u003cp\u003eN for HVPG decrease（percent）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.928348909657322%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.32398753894081%\"\u003e\n \u003cp\u003eall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.165109034267913%\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.757009345794394%\"\u003e\n \u003cp\u003e3.57\u0026plusmn;8.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.411214953271028%\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.414330218068535%\"\u003e\n \u003cp\u003e38（66.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.928348909657322%\"\u003e\n \u003cp\u003e\u003cem\u003e0.001\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.32398753894081%\"\u003e\n \u003cp\u003e5-12mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.165109034267913%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.757009345794394%\"\u003e\n \u003cp\u003e-5.5\u0026plusmn;7.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.411214953271028%\"\u003e\n \u003cp\u003e0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.414330218068535%\"\u003e\n \u003cp\u003e2（20%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.928348909657322%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.32398753894081%\"\u003e\n \u003cp\u003e12-20mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.165109034267913%\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.757009345794394%\"\u003e\n \u003cp\u003e4.40\u0026plusmn;6.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.411214953271028%\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.414330218068535%\"\u003e\n \u003cp\u003e23（71.8%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.928348909657322%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.32398753894081%\"\u003e\n \u003cp\u003e\u0026ge;20mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.165109034267913%\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.757009345794394%\"\u003e\n \u003cp\u003e7.80\u0026plusmn;7.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.411214953271028%\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.414330218068535%\"\u003e\n \u003cp\u003e13（86.7%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.928348909657322%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 3\u0026nbsp;：Comparison between postoperative HVPG decreased group and non-decreased group.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"589\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.106960950764005%\"\u003e\n \u003cp\u003eParameter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.617996604414262%\"\u003e\n \u003cp\u003eNon-decreased group（n=19）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.29711375212224%\"\u003e\n \u003cp\u003eDecreased group（n=38）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97792869269949%\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.106960950764005%\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.617996604414262%\" valign=\"top\"\u003e\n \u003cp\u003e50.95\u0026plusmn;7.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.29711375212224%\" valign=\"top\"\u003e\n \u003cp\u003e45.68\u0026plusmn;12.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97792869269949%\" valign=\"top\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.106960950764005%\"\u003e\n \u003cp\u003eSex \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.617996604414262%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.29711375212224%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97792869269949%\" valign=\"top\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.106960950764005%\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.617996604414262%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.29711375212224%\" valign=\"top\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97792869269949%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.106960950764005%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.617996604414262%\" valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.29711375212224%\" valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97792869269949%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.106960950764005%\"\u003e\n \u003cp\u003eEtiology \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.617996604414262%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.29711375212224%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97792869269949%\" valign=\"top\"\u003e\n \u003cp\u003e0.835\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.106960950764005%\"\u003e\n \u003cp\u003eHepatitis virus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.617996604414262%\" valign=\"top\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.29711375212224%\" valign=\"top\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97792869269949%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.106960950764005%\"\u003e\n \u003cp\u003eouther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.617996604414262%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.29711375212224%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97792869269949%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.106960950764005%\"\u003e\n \u003cp\u003eHistory of bleeding \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.617996604414262%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.29711375212224%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97792869269949%\" valign=\"top\"\u003e\n \u003cp\u003e0.432\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.106960950764005%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.617996604414262%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.29711375212224%\" valign=\"top\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97792869269949%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.106960950764005%\"\u003e\n \u003cp\u003eNO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.617996604414262%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.29711375212224%\" valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97792869269949%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.106960950764005%\"\u003e\n \u003cp\u003ePeroperative FIB-4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.617996604414262%\"\u003e\n \u003cp\u003e5.57(3.96,12.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.29711375212224%\"\u003e\n \u003cp\u003e6.21(3.45,10.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97792869269949%\"\u003e\n \u003cp\u003e0.623\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.106960950764005%\"\u003e\n \u003cp\u003ePeroperative MELD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.617996604414262%\"\u003e\n \u003cp\u003e5.08\u0026plusmn;4.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.29711375212224%\"\u003e\n \u003cp\u003e5.19\u0026plusmn;3.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97792869269949%\"\u003e\n \u003cp\u003e0.914\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.106960950764005%\"\u003e\n \u003cp\u003ePeroperative CTP \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.617996604414262%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.29711375212224%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97792869269949%\"\u003e\n \u003cp\u003e\u003cem\u003e0.015\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.106960950764005%\"\u003e\n \u003cp\u003e\u0026nbsp; A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.617996604414262%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.29711375212224%\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97792869269949%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.106960950764005%\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.617996604414262%\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.29711375212224%\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97792869269949%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.106960950764005%\"\u003e\n \u003cp\u003eBaseline HVPG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.617996604414262%\"\u003e\n \u003cp\u003e13.00\u0026plusmn;4.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.29711375212224%\"\u003e\n \u003cp\u003e18.21\u0026plusmn;5.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97792869269949%\"\u003e\n \u003cp\u003e\u003cem\u003e0.001\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.106960950764005%\"\u003e\n \u003cp\u003eBaseline HVPG group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.617996604414262%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.29711375212224%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97792869269949%\"\u003e\n \u003cp\u003e\u003cem\u003e0.002\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.106960950764005%\"\u003e\n \u003cp\u003elow（5-12mmHg）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.617996604414262%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.29711375212224%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97792869269949%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.106960950764005%\"\u003e\n \u003cp\u003emedium（12-20mmHg）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.617996604414262%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.29711375212224%\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97792869269949%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.106960950764005%\"\u003e\n \u003cp\u003ehigh（\u0026ge;20mmHg）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.617996604414262%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.29711375212224%\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97792869269949%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.106960950764005%\"\u003e\n \u003cp\u003ePostoperative FIB-4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.617996604414262%\"\u003e\n \u003cp\u003e1.55(1.02,2.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.29711375212224%\"\u003e\n \u003cp\u003e1.27(0.84,1.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97792869269949%\"\u003e\n \u003cp\u003e0.198\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.106960950764005%\"\u003e\n \u003cp\u003ePostoperative MELD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.617996604414262%\"\u003e\n \u003cp\u003e0.91\u0026plusmn;4.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.29711375212224%\"\u003e\n \u003cp\u003e1.15\u0026plusmn;3.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97792869269949%\"\u003e\n \u003cp\u003e0.806\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.106960950764005%\"\u003e\n \u003cp\u003ePostoperative CTP \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.617996604414262%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.29711375212224%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97792869269949%\"\u003e\n \u003cp\u003e0.775\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.106960950764005%\"\u003e\n \u003cp\u003eA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.617996604414262%\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.29711375212224%\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97792869269949%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.106960950764005%\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.617996604414262%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.29711375212224%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.97792869269949%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations:HVPG, Hepatic venous pressure gradient; FIB-4, fibrosis-4; MELD, model for end-stage liver disease; CTP, Child-Turcotte-Pugh;\u003c/p\u003e\n\u003cp\u003eTable 4: multivariate logistic regression analysis of the risk factors for decrease of\u0026nbsp;postoperative HVPG\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"594\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.084033613445378%\" valign=\"top\"\u003e\n \u003cp\u003eParameter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.831932773109244%\" valign=\"top\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.04201680672269%\" valign=\"top\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.04201680672269%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.084033613445378%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.831932773109244%\" valign=\"top\"\u003e\n \u003cp\u003e0.582\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.04201680672269%\" valign=\"top\"\u003e\n \u003cp\u003e0.132-2.565\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.04201680672269%\" valign=\"top\"\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.084033613445378%\" valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.831932773109244%\" valign=\"top\"\u003e\n \u003cp\u003e0.975\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.04201680672269%\" valign=\"top\"\u003e\n \u003cp\u003e0.906-1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.04201680672269%\" valign=\"top\"\u003e\n \u003cp\u003e0.509\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.084033613445378%\" valign=\"top\"\u003e\n \u003cp\u003eBaseline HVPG(mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.831932773109244%\" valign=\"top\"\u003e\n \u003cp\u003e1.285\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.04201680672269%\" valign=\"top\"\u003e\n \u003cp\u003e1.092-1.512\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.04201680672269%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e0.002\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.084033613445378%\" valign=\"top\"\u003e\n \u003cp\u003ePreoperation CTP B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.831932773109244%\" valign=\"top\"\u003e\n \u003cp\u003e0.126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.04201680672269%\" valign=\"top\"\u003e\n \u003cp\u003e0.028-0.568\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.04201680672269%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e0.007\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: Variables with P\u0026lt;0.10 between groups were subsequently selected for inclusion in a multivariate logistic regression .\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAbbreviations:HVPG, Hepatic venous pressure gradient; CTP, Child-Turcotte-Pugh;\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"649\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"5\"\u003e\n \u003cp\u003eTable 5：Univariate and Multivariate Cox Regression Analyses on Determinants of (re)bleeding After LSED\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.692307692307693%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.53846153846154%\" colspan=\"2\"\u003e\n \u003cp\u003eUnivariate Analysis, n=9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.76923076923077%\" colspan=\"2\"\u003e\n \u003cp\u003eMultivariate Analysis, n=9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.692307692307693%\"\u003e\n \u003cp\u003eParameter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.692307692307693%\"\u003e\n \u003cp\u003eHR（95% CI）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.846153846153847%\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.692307692307693%\"\u003e\n \u003cp\u003eaHR（95% CI）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.076923076923077%\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.692307692307693%\"\u003e\n \u003cp\u003eBaseline HVPG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.692307692307693%\"\u003e\n \u003cp\u003e1.06（0.37-3.05）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.846153846153847%\"\u003e\n \u003cp\u003e0.908\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.692307692307693%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.076923076923077%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.692307692307693%\"\u003e\n \u003cp\u003eHVPG decreased＞20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.692307692307693%\"\u003e\n \u003cp\u003e0.17（0.04-0.83）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.846153846153847%\"\u003e\n \u003cp\u003e\u003cem\u003e0.029\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.692307692307693%\"\u003e\n \u003cp\u003e0.08（0.01-0.91）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.076923076923077%\"\u003e\n \u003cp\u003e\u003cem\u003e0.042\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.692307692307693%\"\u003e\n \u003cp\u003ePostoperative HVPG \u0026ge;12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.692307692307693%\"\u003e\n \u003cp\u003e3.945（0.81-19.17）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.846153846153847%\"\u003e\n \u003cp\u003e0.089\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.692307692307693%\"\u003e\n \u003cp\u003e1.28（0.15-11.22）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.076923076923077%\"\u003e\n \u003cp\u003e0.822\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.692307692307693%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.692307692307693%\"\u003e\n \u003cp\u003e3.166（0.649-15.441）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.846153846153847%\"\u003e\n \u003cp\u003e0.133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.692307692307693%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.076923076923077%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.692307692307693%\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.692307692307693%\"\u003e\n \u003cp\u003e1.064（1.001-1.133）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.846153846153847%\"\u003e\n \u003cp\u003e\u003cem\u003e0.041\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.692307692307693%\"\u003e\n \u003cp\u003e1.057（0.98-1.16）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.076923076923077%\"\u003e\n \u003cp\u003e0.217\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.692307692307693%\"\u003e\n \u003cp\u003eEtiology（other）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.692307692307693%\"\u003e\n \u003cp\u003e0.538（0.132-2.184）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.846153846153847%\"\u003e\n \u003cp\u003e0.384\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.692307692307693%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.076923076923077%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.692307692307693%\"\u003e\n \u003cp\u003eUGIB history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.692307692307693%\"\u003e\n \u003cp\u003e5.221（0.649-41.98）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.846153846153847%\"\u003e\n \u003cp\u003e\u003cem\u003e0.083\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.692307692307693%\"\u003e\n \u003cp\u003e29.52（1.71-508.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.076923076923077%\"\u003e\n \u003cp\u003e\u003cem\u003e0.02\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.692307692307693%\"\u003e\n \u003cp\u003ePreoperative MELD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.692307692307693%\"\u003e\n \u003cp\u003e0.839(0.67-1.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.846153846153847%\"\u003e\n \u003cp\u003e0.136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.692307692307693%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.076923076923077%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.692307692307693%\"\u003e\n \u003cp\u003ePreoperative FIB-4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.692307692307693%\"\u003e\n \u003cp\u003e1.07（0.93-1.22）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.846153846153847%\"\u003e\n \u003cp\u003e0.347\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.692307692307693%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.076923076923077%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.692307692307693%\"\u003e\n \u003cp\u003ePreoperative CTP B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.692307692307693%\"\u003e\n \u003cp\u003e1.21（0.32-4.50）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.846153846153847%\"\u003e\n \u003cp\u003e0.780\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.692307692307693%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.076923076923077%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.692307692307693%\"\u003e\n \u003cp\u003ePostoperative MELD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.692307692307693%\"\u003e\n \u003cp\u003e0.88（0.71-1.08）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.846153846153847%\"\u003e\n \u003cp\u003e0.218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.692307692307693%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.076923076923077%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.692307692307693%\"\u003e\n \u003cp\u003ePostoperative FIB-4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.692307692307693%\"\u003e\n \u003cp\u003e1.38（0.85-2.25）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.846153846153847%\"\u003e\n \u003cp\u003e0.196\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.692307692307693%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.076923076923077%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.692307692307693%\"\u003e\n \u003cp\u003ePostoperative CTP B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.692307692307693%\"\u003e\n \u003cp\u003e0.040（0.00-1654.4）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.846153846153847%\"\u003e\n \u003cp\u003e0.554\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.692307692307693%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.076923076923077%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eNote: Variables with p \u0026lt; 0.10 in the univariable analysis were then incorporated into a multivariable Cox proportional hazards mode.\u003c/p\u003e\n\u003cp\u003eAbbreviations: HVPG, Hepatic venous pressure gradient; FIB-4, fibrosis-4; MELD, model for end-stage liver disease; CTP, Child-Turcotte-Pugh; UGIB, upper gastrointestinal bleeding;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"liver cirrhosis, portal hypertension, laparoscopic splenectomy plus esophagogastric devascularization, hepatic venous pressure gradient","lastPublishedDoi":"10.21203/rs.3.rs-4567104/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4567104/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eHepatic venous pressure gradient (HVPG) is considered the gold standard for diagnosing portal hypertension (PHT). Laparoscopic splenectomy plus esophagogastric devascularization (LSED) is an important surgery for treating PHT. However, the variation trend of HVPG after surgery is not clear. In addition, whether HVPG could provide precise prognostic information for patients undergoing surgery remains to be further studied. This study aimed to investigate the independent prognostic value of HVPG in LSED.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eFrom January 2016 to March 2023, 134 patients with PHT underwent LSED at our hospital were retrospectively evaluated. The correlations between clinical indicators and history of upper gastrointestinal bleeding (UGIB) were analyzed. Among them, 57 patients remeasured postoperative HVPG. Postoperative alterations of HVPG and correlative factors, as well as the relationship between the HVPG and postoperative UGIB, were further investigated.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn this study, we found that 93 patients with preoperative UGIB (16.27\u0026thinsp;\u0026plusmn;\u0026thinsp;5.73mmHg) had a higher baseline HVPG than the other 41 patients without (14.02\u0026thinsp;\u0026plusmn;\u0026thinsp;5.90mmHg) (P\u0026thinsp;=\u0026thinsp;0.04). The mean postoperative HVPG significantly decreased (-3.57\u0026thinsp;\u0026plusmn;\u0026thinsp;8.09 mmHg, P\u0026thinsp;=\u0026thinsp;0.001) than baseline, 66% of patients (38/57) experienced the decreased HVPG-response after surgery. The baseline HVPG and preoperative CTP class B were associated with the decreased HVPG-response. Additionally, the patients with postoperative HVPG decreased\u0026gt;20% from baseline exhibited better recurrent hemorrhage-free survival rates than those without (log-rank, P\u0026thinsp;=\u0026thinsp;0.013).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eWe found that LSED led to a significantly decreased HVPG, and patients with postoperative HVPG decreased \u0026gt;20% obtained better UGIB-free survival benefits than those without.\u003c/p\u003e","manuscriptTitle":"The independent prognostic value of Perioperative HVPG measurements in patients with portal hypertension and received Laparoscopic splenectomy plus esophagogastric devascularization","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-12 18:35:56","doi":"10.21203/rs.3.rs-4567104/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"99e9ea50-7dc6-4bb5-8083-cd6404eb5375","owner":[],"postedDate":"July 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-30T21:08:35+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-12 18:35:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4567104","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4567104","identity":"rs-4567104","version":["v1"]},"buildId":"GqpaHPwrfC8PjnIFayRh5","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}