Stratified Analysis of the Correlation between Wedged Hepatic Venous Pressure and Portal Venous Pressure in Patients with Portal Hypertension: A Multicenter Study

Stratified Analysis of the Correlation between Wedged Hepatic Venous Pressure and Portal Venous Pressure in Patients with Portal Hypertension: A Multicenter Study | 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 Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Stratified Analysis of the Correlation between Wedged Hepatic Venous Pressure and Portal Venous Pressure in Patients with Portal Hypertension: A Multicenter Study Yifan Lv, Bing Zhu, Dongze Li, Hua Tian, Shaoli You, Sa Lv, Fuchuan Wang, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4597526/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 25 Nov, 2024 Read the published version in Scientific Reports → Version 1 posted 11 You are reading this latest preprint version Abstract Aim: To evaluate the differences in the agreement between wedged hepatic venous pressure (WHVP) and portal venous pressure (PVP) at different hepatic venous pressure gradient (HVPG) levels to provide new guidance for the clinical diagnosis and management of portal hypertension (PHT). Methods: A multicenter study of 785 patients with PHT from three centers was stratified into five groups by their HVPG: <12 (group A), 12 ≤ HVPG < 16 mmHg (group B), 16 ≤ HVPG < 20 mmHg (group C), 20 ≤ HVPG < 24 mmHg (group D), ≥24 mmHg (group E). Concordance was analyzed using Pearson’s correlation coefficient (R), the intraclass correlation coefficient (ICC), and Bland‒Altman analysis in each HVPG stratum. Results: Correlation and agreement between WHVP and PVP varied by HVPG group. Highest agreement was observed in the range of 20 ≤ HVPG < 24 mmHg. (R=0.52, ICC=0.66). The proportion of patients with a discrepancy between WHVP and PVP that was greater than 10% of the PVP value was highest in group A (95.3%) and lowest in group D (51.3%). Overestimation of PVP was more common in group E (48.5%), and underestimation of PVP was more common in group A (93.8%). Conclusions: The correlation between WHVP and PVP varies significantly across HVPG levels, the highest agreement being in the range of 20 ≤ HVPG < 24 mmHg. WHVP frequently underestimates PVP when HVPG is < 12 mmHg and tends to overestimate PVP when HVPG is ≥ 24 mmHg. Health sciences/Gastroenterology/Hepatology Health sciences/Gastroenterology/Hepatology/Liver diseases/Portal hypertension wedged hepatic venous pressure portal venous pressure hepatic venous pressure gradient stratified analysis portal hypertension Figures Figure 1 Figure 2 Figure 3 Introduction Portal hypertension (PHT) is one of the most common and severe complications of cirrhosis, affecting millions of patients worldwide and significantly impacting their quality of life and survival rates [ 1 ] . It typically signifies the progression of liver disease to an advanced stage, necessitating active monitoring and management. The clinical manifestations of PHT include gastrointestinal bleeding, ascites, and hepatic encephalopathy, making accurate assessment of portal venous pressure (PVP) crucial for the prevention and treatment of high-risk patients [ 2 , 3 ] . Traditional methods of measuring PVP are highly invasive and carry significant risks, making noninvasive assessment techniques, such as the estimation of PVP from wedged hepatic venous pressure (WHVP), critical in clinical practice. To mitigate the influence of ascites or intra-abdominal pressure, which may artificially elevate WHVP, the hepatic venous pressure gradient (HVPG), the discrepancy between WHVP and the free hepatic vein pressure (FHVP), is often measured [ 4 , 5 ] . The consistency between WHVP and PVP is a pivotal factor in the assessment of PHT, and its accuracy directly correlates with the diagnosis and subsequent treatment of PHT [ 6 , 7 ] . WHVP has been correlated with PVP, but these investigations often overlooked the diversity of etiologies and the potential impact of disease progression on this relationship [ 8 – 10 ] . Moreover, our understanding of how HVPG affects the concordance between WHVP and PVP is superficial. HVPG ≥ 12 mmHg can indicate cirrhosis and PHT decompensation [ 11 ] . A measurement error of HVPG > 4 mmHg can seriously affect the judgment of clinical results and the choice of treatment [ 12 ] . On this foundation, the present study stratified HVPG and explored the consistency between WHVP and PVP in different HVPG strata using a large-scale, multicenter approach. Our aim is to provide a more accurate PHT assessment method for clinicians, thereby improving the treatment outcomes and prognosis of patients with PHT. Materials and Methods Patients This retrospective study analyzed patients who underwent transjugular intrahepatic portosystemic shunt (TIPS) surgery at three different Beijing hospitals that have extensive experience in TIPS procedures and venous pressure measurements in Beijing Shijitan Hospital, Beijing You’an Hospital and the Fifth Medical Center of Chinese People's Liberation Army General Hospital (302 Hospital) between January 2020 and June 2023. The study included 785 patients with PHT (Fig. 1 ). Inclusion criteria: patients aged 18 years or older with a confirmed diagnosis of PHT who were scheduled for TIPS treatment, in whom WHVP and PVP were successfully measured intraoperatively. Exclusion criteria: history of malignant hepatobiliary system tumors, occlusive portal vein thrombosis, previous history of hepatic transplantation, recent use of drugs affecting portal vein pressure, and severe cardiopulmonary disease. The study was carried out in compliance with the relevant guidelines and the Declaration of Helsinki, having received approval from the ethical committees of the participating hospitals. Informed consent was obtained from all patients. Measurement of WHVP and PVP Preoperative preparation (1) All patients stopped taking drugs that affect portal vein pressure for at least 1 week before surgery. (2) They underwent relevant laboratory tests, including complete blood count, coagulation function, liver and kidney function, electrolytes, ammonia levels, blood type, and indocyanine green retention rate at 15 minutes (a quantitative liver function testICG-R15). (3) They underwent an electrocardiogram, echocardiography, and chest X-ray in both anterior-posterior and lateral views to exclude severe cardiopulmonary diseases. (4) They underwent ultrasound of the portal vein, enhanced abdominal CT and MRI to clarify the conditions of the hepatic veins, portal vein, and its branches. (5) We informed the patient and the patient’s family about the patient's condition, the expected outcomes of the procedure, the potential risks as documented, and alternative options in case of those risks. Every willing participant signed an informed consent agreement for the procedure. Pressure measurement The measurements were performed by experienced interventional radiologists according to a standard protocol [ 13 ] . After disinfection and local anesthesia, a catheter sheath was introduced into the right internal jugular vein, and pressure within the right atrium and inferior vena cava was measured using the RUPS-100 system (COOK Medical, USA). After confirming venous patency with hepatic venography, a Fogarty balloon catheter (Edwards Lifesciences, USA) connected to a pressure sensor was inserted into the hepatic vein via a 10 F sheath for pressure assessment. FHVP and WHVP were determined by positioning the balloon catheter tip 3–5 cm from the inferior vena cava and achieving complete venous occlusion (5 ml of contrast medium was injected for hepatic venography to confirm the absence of contrast reflux and venous collateral flow). The measurements were adjusted for occlusion adequacy and were done three times for accuracy. Under fluoroscopic guidance, the hepatic vein was punctured into the portal vein, and PVP and inferior vena cava pressure (IVCP) were measured by advancing a pigtail catheter into the splenic vein or superior mesenteric vein. This procedure was performed three times to calculate the average pressure values. HVPG was calculated as WHVP minus FHVP, and the portal pressure gradient (PPG) was calculated as PVP minus IVCP [ 14 ] , after which we did the TIPS procedure. Groups and definitions Patients were divided into 5 groups according to their HVPG values. Patients with HVPG ≤ 12 mmHg were defined as group A, patients with 12 < HVPG ≤ 16 mmHg were defined as group B, patients with 16 < HVPG ≤ 20 mmHg were defined as group C, and patients with 20 < HVPG ≤ 24 mmHg were defined as group D, and patients with HVPG ≥ 24 mmHg were defined as group E. WHVP and PVP were defined as in agreement when both pressures differed by ≤ 10% of the PVP value. WHVP and PVP were in disagreement when both pressures differed by > 10% of the PVP value [ 9 ] . WHVP was defined as underestimating PVP when WHVP was more than 10% lower than PVP. WHVP was defined as overestimating PVP when WHVP was more than 10% higher than PVP [ 8 ] . Statistical analysis SPSS 25.0 (SPSS, Inc., Chicago, IL, USA) and GraphPad Prism 9 (GraphPad, Inc., San Diego, CA, USA) were used for statistical analysis and graphing. Continuous variables with a normal or near-normal distribution are reported as mean ± standard deviation, and nonnormally distributed variables are reported as median [interquartile range, IQR]. The chi-squared test or Fisher’s exact test was used to compare groups on categorical variables, while Student’s t test or the Mann‒Whitney U test was used for continuous ones. Within-group differences between WHVP and PVP were examined using the paired t test or Wilcoxon signed-rank test, as appropriate. WHVP–PVP agreement was assessed via Pearson’s correlation coefficient (R), the intraclass correlation coefficient (ICC), and Bland‒Altman analysis. A higher ICC and R along with narrower Bland‒Altman 95% limits of agreement (95% LoA, mean difference ± 1.96 standard deviation) indicated better consistency [ 15 ] . P < 0.05 meant a difference was statistically significant. Results Baseline characteristics In this study, a cohort of 785 patients with PHT who met the inclusion criteria was recruited from three centers. The cohort comprised 538 males (68.5%) and 247 females (31.5%), with an age distribution ranging from 18 to 80 years and a mean age of 53 ± 12 years. The etiology of PHT was categorized as follows: hepatitis B virus-related cirrhosis in 351 cases, hepatitis C virus-related cirrhosis in 42 cases, alcoholic cirrhosis in 95 cases, autoimmune liver diseases in 88 cases, hepatic veno-occlusive disease/hepatic sinusoidal obstruction syndrome in 90 cases, drug-induced liver injury in 18 cases, idiopathic PHT in 61 cases, and cryptogenic cirrhosis in 40 cases. Among the participants, 617 patients (78.6%) presented with gastrointestinal bleeding, 77 patients (9.8%) with refractory ascites/hydrothorax, and 91 patients (11.6%) with gastrointestinal bleeding combined with refractory ascites. All patients successfully underwent pressure measurements and the TIPS procedure without any surgery-related complications or deaths. From their HVPG measurements, the patients were stratified into five groups: group A with HVPG < 12 mmHg (258 patients, 32.9%), group B with 12 ≤ HVPG < 16 mmHg (104 patients, 13.2%), group C with 16 ≤ HVPG < 20 mmHg (141 patients, 18.0%), group D with 20 ≤ HVPG < 24 mmHg (113 patients, 14.4%), and group E with HVPG ≥ 24 mmHg (169 patients, 21.5%). Patient demographics and baseline characteristics are detailed in Table 1 . Table 1 Baseline characteristics of the included patients. Parameters Group A n = 258 Group B n = 104 Group C n = 141 Group D n = 113 Group E n = 169 Sex (male) 167 (64.7%) 65 (62.5%) 103 (73.0%) 84 (74.3%) 119 (70.4%) Age (years) 51.8 ± 12.7 54.6 ± 12.2 53.1 ± 12.1 53.9 ± 12.5 53.2 ± 12.5 Etiology HBV 106 (41.1%) 48 (46.2%) 63 (44.7%) 52 (46.0%) 82 (48.5%) HCV 7 (2.7%) 4 (3.8%) 10 (7.1%) 9 (8.0%) 12 (7.1%) ALC 32 (12.4%) 10 (9.6%) 19 (13.5%) 12 (10.6%) 22 (13.0%) ALD 28 (10.9%) 16 (15.4%) 16 (11.3%) 14 (12.4%) 14 (8.3%) DILI 8 (3.1%) 3 (2.9%) 2 (1.4%) 1 (0.9%) 4 (2.4%) HVOD/HSOS 35 (13.6%) 12 (11.5%) 15 (10.6%) 11 (9.7%) 17 (10.1%) IPH 30 (11.6%) 5 (4.8%) 9 (6.4%) 6 (5.3%) 11 (6.5%) Other 12 (4.6%) 6 (5.8%) 7 (5.0%) 8 (7.1%) 7 (4.1%) Indication Variceal bleeding 208 (80.6%) 80 (76.9%) 115 (81.6%) 87 (77.0%) 127 (75.1%) Ascites 25 (9.7%) 11 (10.6%) 11 (7.8%) 16 (14.2%) 14 (8.3%) Both 25 (9.7%) 13 (12.5%) 15 (10.6%) 10 (8.8%) 28 (16.6) Laboratory values ALT (U/L) 20.0 (13.0–29.0) 18.5 (14.0-30.5) 19.0 (13.0–27.0) 21.5 (15.0–31.0) 20.0 (15.0–27.0) AST (U/L) 25.0 (20.0–35.0) 28.5 (23.0–42.0) 26.0 (20.0-36.5) 30.0 (22.0-44.8) 29.5 (23.0–43.0) ALP (U/L) 89.0 (68.0-128.0) 91.0 (64.3–141.0) 80.0 (60.5-112.5) 84.0 (61.0-116.8) 92.5 (70.0-124.5) GGT (U/L) 37.0 (20.0–59.0) 40.0 (19.0-77.3) 35.0 (16.0-72.5) 39.5 (18.0-83.3) 41.5 (21.3–93.0) ALB (g/L) 36.9 ± 4.9 35.6 ± 5.6 35.5 ± 5.8 34.2 ± 5.6 34.6 ± 4.5 Cr (µmol/L) 61.0 (52.0–69.0) 65.0 (51.3–75.0) 62.0 (51.5–76.0) 62.0 (51.0–73.0) 62.0 (51.0–74.0) TB (µmol/L) 21.5 (14.3–30.6) 21.4 (16.5–33.4) 22.7 (16.0-32.6) 27.1 (17.0-38.8) 25.2 (17.3–39.2) INR 1.2 (1.1–1.4) 1.3 (1.2–1.4) 1.3 (1.2–1.5) 1.3 (1.2–1.5) 1.3 (1.2–1.5) APTT (s) 32.7 (30.1–35.4) 32.6 (30.7–35.3) 32.5 (30.3–36.0) 33.4 (31.4–37.0) 33.6 (31.0-37.2) PT (s) 13.6 (12.4–15.4) 13.8 (12.7–15.0) 14.5 (13.3–16.1) 14.5 (12.8–16.2) 14.4 (13.3–16.2) Hb (g/L) 96.4 ± 26.5 94.9 ± 26.0 88.5 ± 26.4 94.7 ± 24.5 90.6 ± 23.1 WBC (×10 9 /L) 3.0 (2.0-4.3) 2.8 (1.8–4.3) 2.9 (1.7–4.3) 2.9 (1.9–4.4) 2.8 (1.9–4.1) PLT (×10 9 /L)) 89.0 (51.0-163.0) 77.5 (51.0-113.0) 75.0 (52.0-107.5) 76.5 (50.0-118.0) 74.0 (51.3–112.0) Child‒Pugh score 6.0 (5.0–7.0) 7.0 (6.0–7.0) 7.0 (6.0–8.0) 7.0 (6.0–8.0) 7.0 (6.0–8.0) Hemodynamics (mmHg) WHVP 17.9 ± 6.0 24.7 ± 4.3 28.0 ± 3.9 32.9 ± 4.4 39.0 ± 6.6 PVP 32.9 ± 7.5 33.5 ± 7.0 33.1 ± 6.7 33.5 ± 6.3 34.9 ± 6.4 FHVP 11.0 ± 4.7 11.0 ± 4.3 10.3 ± 3.8 11.3 ± 4.1 10.9 ± 4.0 IVCP 8.5 ± 3.6 8.3 ± 3.8 8.0 ± 3.4 8.2 ± 3.1 8.4 ± 3.6 HVPG 6.8 ± 3.3 13.7 ± 1.2 17.7 ± 1.1 21.7 ± 1.2 28.1 ± 4.9 PPG 24.7 ± 6.6 25.5 ± 7.4 25.2 ± 6.4 25.5 ± 6.1 26.6 ± 6.1 HBV: hepatitis B virus–related cirrhosis; HCV: hepatitis C virus–related cirrhosis; ALC: alcoholic liver cirrhosis; ALD: autoimmune liver disease; DILI: drug-induced liver injury; HVOD: hepatic veno-occlusive disease; HSOS: hepatic sinusoidal obstruction syndrome; IPH: idiopathic portal hypertension; Other: liver cirrhosis of unknown cause; ALT: alanine aminotransferase; AST: aspartate aminotransferase; ALP: alkaline phosphatase; GGT: γ-glutamyl transpeptidase; ALB: albumin; TB: total bilirubin; INR: international normalized ratio; APTT: activated partial thromboplastin time; PT: prothrombin time; Hb: hemoglobin; WBC: white blood cell; PLT: platelet; WHVP: wedged hepatic venous pressure; PVP: portal venous pressure; FHVP: free hepatic venous pressure; IVCP: inferior vena cava pressure; HVPG: hepatic venous pressure gradient; PPG: portal venous pressure gradient. Agreement analysis between WHVP and PVP Table 2 displays the Pearson’s R, ICC, and 95%LoA for WHVP and PVP across the different groups. Group D, (20 ≤ HVPG < 24 mmHg) exhibited the strongest correlation between WHVP and PVP (R = 0.52, P < 0.001) and highest ICC (ICC = 0.66, P < 0.001), suggesting that the best concordance between WHVP and PVP was within this range. This R and ICC indicated moderate agreement. The R and ICC values in the other groups were as follows: group A: R = 0.27 ( P < 0.001), ICC = 0.14 ( P < 0.001); group B: R = 0.21 ( P = 0.036), ICC = 0.16 ( P = 0.03); group C: R = 0.35 ( P < 0.001), ICC = 0.35 ( P < 0.001); and group E: R = 0.31 ( P < 0.001), ICC = 0.42 ( P < 0.001). These four strata all showed poor agreement between WHVP and PVP. Table 2 Correlations between wedged hepatic venous pressure and portal venous pressure. R P ICC P value 95%LoA Group A HVPG < 12 mmHg 0.27 < 0.001 0.14 < 0.001 0.77–15.64 Group B 12 ≤ HVPG < 16 mmHg 0.21 0.036 0.16 0.03 0.39–15.65 Group C 16 ≤ HVPG < 20 mmHg 0.35 < 0.001 0.35 < 0.001 1.12–14.68 Group D 20 ≤ HVPG < 24 mmHg 0.52 < 0.001 0.66 < 0.001 1.78–14.30 Group E HVPG ≥ 24 mmHg 0.31 < 0.001 0.42 < 0.001 1.38–15.22 HVPG: hepatic venous pressure gradient; R: Pearson’s correlation coefficient; ICC: interclass correlation coefficient; 95%LoA: 95% limits of agreement (mean difference ± 1.96 standard deviation). When assessing the concordance between WHVP and PVP using Bland‒Altman analysis, a wider 95% LoA suggested poorer agreement. Correspondingly, as revealed in Table 2 , group D's WHVP and PVP (Fig. 2 ) had the narrowest 95% LoA, indicating the best concordance. Group B had the widest 95% LoA, signifying the poorest agreement. These findings align with the results from the Pearson correlation analysis. Performance of WHVP in evaluating PVP The mean values of WHVP and PVP across the different groups are presented in Table 1 . In group A, the average WHVP was approximately 15 mmHg lower than the average PVP, a significant difference ( P < 0.001). In group B, the average WHVP was around 9 mmHg lower than the average PVP ( P < 0.001). In group C, the average WHVP was about 5 mmHg lower than the average PVP ( P < 0.001). Group D exhibited the closest mean values between WHVP and PVP, with a difference of less than 1 mmHg, which were not statistically significant ( P = 0.196). In group E, the average WHVP was approximately 4 mmHg higher than the average PVP ( P < 0.001). The comparisons between WHVP and PVP across the groups are depicted in Fig. 3 . As indicated in Table 3 , more patients in group D had WHVP–PVP agreement (difference ≤ 10% PVP) than any other group, at 48.7%, whereas group A had the highest proportion of disagreement (difference > 10% PVP), at 95.3%. By integrating the data from Table 3 with Fig. 3 , we saw that among patients whose WHVP was lower than their PVP, 93.8% were from group A. This suggests that when HVPG is < 12 mmHg, WHVP often underestimates PVP. As the pressures gradually increased, the concordance between WHVP and PVP also increases till it reached its maximum in group D. Moreover, among patients whose WHVP was greater than their PVP, the largest proportion was found in group E, at 48.5%, indicating that when HVPG is ≥ 24 mmHg, WHVP often overestimates PVP (the differences were statistically significant after applying Bonferroni correction for multiple comparisons). Table 3 Performance of wedged hepatic venous pressure in assessing portal venous pressure. Group A n = 258 Group B n = 104 Group C n = 141 Group D n = 113 Group E n = 169 P value Agreement between WHVP and PVP 12 (4.7%) 25 (24.0%) 48 (34.0%) 55 (48.7%) 71 (42.0%) < 0.001 Disagreement between WHVP and PVP 246 (95.3%) 79 (76.0%) 93 (66.0%) 58 (51.3%) 98 (58.0%) Underestimation of PVP 242 (93.8%) 77 (74.0%) 77 (54.6%) 31 (27.4%) 16 (9.5%) < 0.001 Overestimation of PVP 4 (1.5%) 2 (2.0%) 16 (11.4%) 27 (23.9%) 82 (48.5%) < 0.001 WHVP: wedged hepatic venous pressure; PVP: portal venous pressure Discussion HVPG is the most commonly used clinical parameter for assessing sinusoidal PHT in patients with cirrhosis, serving as the gold standard for identifying the presence of clinically significant PHT (defined as HVPG ≥ 10 mmHg) [ 16 ] . Stratified management of HVPG plays a pivotal role in disease prognostic assessment [ 17 ] , monitoring therapeutic responses [ 18 ] , predicting complications [ 19 ] , and guiding liver transplantation decisions [ 20 ] . WHVP is a key variable in calculating HVPG, and accurately reflecting PVP is a prerequisite for the HVPG-based diagnosis of PHT. Although numerous studies [ 9 , 21 , 22 ] have indicated that the correlation between WHVP and PVP is influenced by various factors, such as etiology and hepatic vascular anatomy, research integrating their relationship with HVPG stratification remains scarce. In this study, we conducted a multicenter analysis of HVPG strata to investigate the various correlations between WHVP and PVP. Through a detailed analysis of 785 patients, we found the significant impact of HVPG on the concordance between WHVP and PVP, providing important insights for the optimization of management and treatment strategies for PHT. Our study indicates that the overall correlation between WHVP and PVP is relatively weak, which may be attributed to our inclusion of patients with various etiologies of PHT, such as cryptogenic cirrhosis, hepatic veno-occlusive disease/hepatic sinusoidal obstruction syndrome, leading to nonsinusoidal PHT. Our work is the first to demonstrate that the concordance between WHVP and PVP varies with changes in HVPG. The best concordance was in group D (HVPG between 20 and 24 mmHg) and the worst in group A (HVPG < 12 mmHg). We set a threshold for concordance at 10% of the magnitude of PVP, calling WHVP and PVP discordant when their difference passed this threshold, in which case WHVP did not accurately reflect PVP. Accordingly, we found that the highest proportion of patients had HVPG < 12 mmHg (95.3%), and the lowest proportion had an HVPG in the 20 ~ 24 mmHg range (51.3%), providing an important reference standard for clinical assessment. Clinically, for patients undergoing secondary prevention, HVPG < 12 mmHg or a reduction of 20% from baseline indicates a decreased probability of rebleeding [ 23 ] . For such patients, a comprehensive assessment incorporating clinical symptoms and laboratory tests should be conducted to make an accurate judgment on secondary prevention. Our study further revealed that when HVPG is < 12 mmHg, WHVP often underestimates PVP, which may be related to the presence of anatomical shunting in hepatic vessels and changes in hepatic hemodynamics. Extensive research by our group [ 24 – 27 ] has indicated that the presence of hepatic venous collaterals is a key factor contributing to the underestimation of PPG by HVPG. Specifically, when the hepatic vein is occluded with a balloon to measure WHVP, the presence of collaterals allows a portion of the hepatic venous blood flow to return to the systemic circulation through these collaterals, resulting in a lower measured pressure. Therefore, in conjunction with the findings of this study, we can infer that the lower the HVPG is, the more pronounced the underestimation of PVP by WHVP becomes, suggesting that at this point, diversion through collaterals plays a dominant role. One study [ 28 ] has shown that the underestimation of PVP by WHVP could be attributed to presinusoidal PHT, yet the underlying pathophysiological mechanisms remain unclear. Whether these patients with presinusoidal PHT predominantly have HVPG < 12 mmHg warrants further investigation. WHVP often overestimated PVP in group E (HVPG ≥ 24 mmHg), which may be associated with their abnormal perfusion of hepatic blood flow. Our previous studies [ 24 – 27 ] indicated that the absence of collaterals between hepatic veins and between hepatic and portal veins could lead HVPG to overestimate PPG. In such scenarios, the blood flow and sinusoidal pressure in the liver might depend mostly on hepatic arterial perfusion, possibly even resulting in a reversal of the direction of portal vein blood flow. The findings of the current study suggest that the higher the HVPG is, particularly above 24 mmHg, the more pronounced the overestimation of PVP becomes, indicating that the blood supply to the sinusoids may come mostly from the hepatic artery under these conditions. Other studies have shown that an WHVP often overestimates PVP when the PHT includes a postsinusoidal component [ 3 , 8 ] . This may be related to the presence of reversed hepatic blood flow, the opening of paraumbilical veins, and the formation of portocaval anastomoses. Whether this phenomenon of postsinusoidal PHT occurs more in patients with HVPG ≥ 24 mmHg requires further research. Despite the valuable insights provided by our study, it has some limitations. First, it did not delve into the physiological mechanisms underlying the discrepancies in concordance between WHVP and PVP. This will be an important direction for future research. Second, although the patients had a wide range of etiologies of PHT, the these causes might not have been subdivided finely enough. Specific etiologies, such as hepatitis B virus, hepatitis C virus, and alcoholic liver disease, may have different impacts on the physiological effects of PHT and thus on the concordance between WHVP and PVP. The failure to finely distinguish these causes may obscure the impact of etiology-specific factors. Future research should aim to overcome these limitations, enhancing the generalizability of the results, through multicentric and international collaborative studies. In summary, through a large-scale, multicentric design, this study conducted an in-depth analysis of the concordance between WHVP and PVP in patients with PHT and revealed the impact of HVPG on their concordance. These findings underscore the importance of considering HVPG when evaluating patients with PHT, as well as the necessity of identifying potential discrepancies between WHVP and PVP when formulating treatment strategies. Despite certain limitations, our research provides valuable information and new directions for future clinical practice, which we hope will help optimize management strategies for PHT and improve patient outcomes. Abbreviations HVPG: hepatic venous pressure gradient; ICC: intraclass correlation coefficient; PHT: portal hypertension; PVP: portal venous pressure; R: Pearson’s correlation coefficient; WHVP: wedged hepatic venous pressure. Declarations Acknowledgments We would like to express our gratitude to all the medical staff of the Liver disease Minimally Invasive Diagnosis and Treatment Center of Beijing Shijitan Hospital affiliated to Capital Medical University, Liver Vascular disease Diagnosis and Treatment Center of Fifth Medical Center of Chinese PLA General Hospital and Department of Gastroenterology and Hepatology of Beijing You'an Hospital affiliated to Capital Medical University for assisting in the collection of clinical data. Data Availability Statements The data underlying this article will be shared on reasonable request to the corresponding author. Funding: The study was supported by the Talent Training Plan during the "14th Five-Year Plan" period of Beijing Shijitan Hospital affiliated to Capital Medical University (2023LJRCLFQ) and National Multi-Center Clinical Research Project of Peking University First Hospital (2022cz020301) to Fuquan Liu. Conflicting interests: The authors declare that they have no conflict of interest. Disclosure of Ethical Statements: The study was approved by the Ethics Committee and Institutional Review Board of Beijing Shijitan Hospital, Beijing You'an Hospital and the Fifth Medical Center of Chinese PLA General Hospital. Availability of data and materials: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Authors' contributions: Fuquan Liu, Yongping Yang and Huiguo Ding designed the research; Bing Zhu, Dongze Li, Hua Tian, Shaoli You, Fuchuan Wang, Sa Lv, Yifan Wu, Chengbin Dong and Yu Zhang performed the research; Yifan Lv analyzed the data and wrote the paper; Fuquan Liu reviewed and edited the manuscript. All authors read and approved the manuscript. References SAAB S. Portal Hypertension [J]. Clin Liver Dis, 2019, 23(4): xiii-xiv. SIMONETTO D A, LIU M, KAMATH P S. 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Nat Rev Gastroenterol Hepatol, 2009, 6(10): 573-82. BLAND J M, ALTMAN D G. Statistical methods for assessing agreement between two methods of clinical measurement [J]. Lancet, 1986, 1(8476): 307-10. DE FRANCHIS R, BOSCH J, GARCIA-TSAO G, et al. Baveno VII - Renewing consensus in portal hypertension [J]. J Hepatol, 2022, 76(4): 959-74. PATERNOSTRO R, BECKER J, HOFER B S, et al. The prognostic value of HVPG-response to non-selective beta-blockers in patients with NASH cirrhosis and varices [J]. Dig Liver Dis, 2022, 54(4): 500-8. ALBILLOS A, BANARES R, GONZALEZ M, et al. Value of the hepatic venous pressure gradient to monitor drug therapy for portal hypertension: a meta-analysis [J]. Am J Gastroenterol, 2007, 102(5): 1116-26. LA MURA V, GARCIA-GUIX M, BERZIGOTTI A, et al. A Prognostic Strategy Based on Stage of Cirrhosis and HVPG to Improve Risk Stratification After Variceal Bleeding [J]. Hepatology, 2020, 72(4): 1353-65. GIABICANI M, JOLY P, SIGAUT S, et al. Predictive Role of Hepatic Venous Pressure Gradient in Bleeding Events Among Cirrhotic Patients Undergoing Orthotopic Liver Transplantation [J]. JHEP Reports, 2024: 101051. OSADA Y, KANAZAWA H, NARAHARA Y, et al. Wedged hepatic venous pressure does not reflect portal pressure in patients with cirrhosis and hepatic veno-venous communications [J]. Dig Dis Sci, 2008, 53(1): 7-13. POMIER-LAYRARGUES G, KUSIELEWICZ D, WILLEMS B, et al. Presinusoidal portal hypertension in non-alcoholic cirrhosis [J]. Hepatology, 1985, 5(3): 415-8. BAIGES A, HERNANDEZ-GEA V, BOSCH J. Pharmacologic prevention of variceal bleeding and rebleeding [J]. Hepatol Int, 2018, 12(Suppl 1): 68-80. LIU B, ZHANG D, DONG C, et al. Correlation between hepatic venous pressure gradient and portal pressure gradient in patients with autoimmune cirrhotic portal hypertension and collateral branches of the hepatic vein [J]. Hepatol Res, 2023, 53(11): 1084-95. LV Y, SONG Q, YUE Z, et al. Correlation between hepatic venous pressure gradient and portal venous pressure gradient in hepatitis B cirrhosis with different hepatic veins anatomy [J]. Eur J Radiol, 2022, 155: 110463. ZHANG D, WANG T, YUE Z D, et al. Hepatic venous pressure gradient: Inaccurately estimates portal venous pressure gradient in alcoholic cirrhosis and portal hypertension [J]. World J Gastrointest Surg, 2023, 15(11): 2490-9. WANG L, SONG Q K, YUE Z D, et al. [Study on the correlation between PPG and HVPG in patients with portal hypertension] [J]. Zhonghua Gan Zang Bing Za Zhi, 2022, 30(7): 722-7. MADIR A, GRGUREVIC I, TSOCHATZIS E A, PINZANI M. Portal hypertension in patients with nonalcoholic fatty liver disease: Current knowledge and challenges [J]. World J Gastroenterol, 2024, 30(4): 290-307. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 25 Nov, 2024 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 27 Sep, 2024 Reviews received at journal 26 Sep, 2024 Reviewers agreed at journal 13 Sep, 2024 Reviews received at journal 27 Aug, 2024 Reviewers agreed at journal 18 Aug, 2024 Reviewers agreed at journal 12 Aug, 2024 Reviewers invited by journal 07 Aug, 2024 Editor assigned by journal 07 Aug, 2024 Editor invited by journal 21 Jun, 2024 Submission checks completed at journal 19 Jun, 2024 First submitted to journal 18 Jun, 2024 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. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board 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-4597526","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":322901800,"identity":"fb68c83f-23ca-43b3-9a2f-bc032121ce1b","order_by":0,"name":"Yifan Lv","email":"","orcid":"","institution":"Beijing Shijitan Hospital, Capital Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yifan","middleName":"","lastName":"Lv","suffix":""},{"id":322901801,"identity":"d6285d12-c0c2-45e5-93f0-44b2a7d10387","order_by":1,"name":"Bing Zhu","email":"","orcid":"","institution":"Fifth Medical Center of Chinese PLA General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Bing","middleName":"","lastName":"Zhu","suffix":""},{"id":322901802,"identity":"e2ed74f1-d4ed-4327-887f-7bd8fa576336","order_by":2,"name":"Dongze Li","email":"","orcid":"","institution":"Fifth Medical Center of Chinese PLA General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Dongze","middleName":"","lastName":"Li","suffix":""},{"id":322901803,"identity":"969d1c3d-55d3-47c1-8a84-f61d82e592eb","order_by":3,"name":"Hua Tian","email":"","orcid":"","institution":"Fifth Medical Center of Chinese PLA General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hua","middleName":"","lastName":"Tian","suffix":""},{"id":322901804,"identity":"68b87819-c536-4aee-9c7d-d604823caec9","order_by":4,"name":"Shaoli You","email":"","orcid":"","institution":"Fifth Medical Center of Chinese PLA General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Shaoli","middleName":"","lastName":"You","suffix":""},{"id":322901805,"identity":"4e9dea24-b058-46db-81ec-155c52fbd10a","order_by":5,"name":"Sa Lv","email":"","orcid":"","institution":"Fifth Medical Center of Chinese PLA General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Sa","middleName":"","lastName":"Lv","suffix":""},{"id":322901806,"identity":"131c3339-cc73-4314-941f-4c1432be6549","order_by":6,"name":"Fuchuan Wang","email":"","orcid":"","institution":"Fifth Medical Center of Chinese PLA General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Fuchuan","middleName":"","lastName":"Wang","suffix":""},{"id":322901807,"identity":"84273884-bfa2-414b-8e03-c1c2c5415fc6","order_by":7,"name":"Yongping Yang","email":"","orcid":"","institution":"Fifth Medical Center of Chinese PLA General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yongping","middleName":"","lastName":"Yang","suffix":""},{"id":322901808,"identity":"faee0df0-9770-4ab1-be37-c27d5ca6879a","order_by":8,"name":"Huiguo Ding","email":"","orcid":"","institution":"Beijing You'an Hospital Affiliated to Capital Medical University","correspondingAuthor":false,"prefix":"","firstName":"Huiguo","middleName":"","lastName":"Ding","suffix":""},{"id":322901809,"identity":"7f825116-5d55-453e-bcc1-17643b93f977","order_by":9,"name":"Yifan Wu","email":"","orcid":"","institution":"Beijing Shijitan Hospital, Capital Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yifan","middleName":"","lastName":"Wu","suffix":""},{"id":322901810,"identity":"0f398392-2b9e-406c-a809-5f4ac8fd1801","order_by":10,"name":"Chengbin Dong","email":"","orcid":"","institution":"Beijing Shijitan Hospital, Capital Medical University","correspondingAuthor":false,"prefix":"","firstName":"Chengbin","middleName":"","lastName":"Dong","suffix":""},{"id":322901811,"identity":"83528bdb-2ec2-4acb-b712-6572c12d1c8d","order_by":11,"name":"Yu Zhang","email":"","orcid":"","institution":"Beijing Shijitan Hospital, Capital Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yu","middleName":"","lastName":"Zhang","suffix":""},{"id":322901812,"identity":"d567253a-3231-4b07-b693-c62f121b7916","order_by":12,"name":"Fuquan Liu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvElEQVRIiWNgGAWjYBACPuYDYFqOgZ2xgTgtbGwJYNqYgZlULYkNzMQ6jI2Nx/A2T82d9P5m5jZp3h0M8vxiBwhqMbbmOfYsd8ZhRqCWMwyGM2cnENAi32MmzcN2OLcBrKWNIcHgNiEtbDxALf8Op8uTpoW37XCCAQla2Iot5/YdNtx4mLHZcm6bBGG/8LMxb7zx5tthebnj7Q9vvG2zkeeXJqAFBCSgNIsEgk2kFuYPxKkfBaNgFIyCkQYAf8A3/npKEIEAAAAASUVORK5CYII=","orcid":"","institution":"Beijing Shijitan Hospital, Capital Medical University","correspondingAuthor":true,"prefix":"","firstName":"Fuquan","middleName":"","lastName":"Liu","suffix":""}],"badges":[],"createdAt":"2024-06-18 05:44:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4597526/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4597526/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-024-80870-9","type":"published","date":"2024-11-25T15:56:57+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":60595327,"identity":"06488a1f-a160-4eca-931a-550cc06ecb55","added_by":"auto","created_at":"2024-07-18 15:29:47","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":38959,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlowchart depicting the patient recruitment and stratification process. 302 Hospital: The Fifth Medical Center of Chinese People’s Liberation Army General Hospital. TIPS: transjugular intrahepatic portosystemic shunt; HVPG: hepatic venous pressure gradient.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4597526/v1/8765084252fdd74370c59e80.jpg"},{"id":60594321,"identity":"0067d9b1-1040-42e5-aa3a-6bee45e62797","added_by":"auto","created_at":"2024-07-18 15:21:47","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":71566,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eBland–Altman plots of the agreement between WHVP and PVP. A: HVPG \u0026lt; 12 mmHg; B:\u003c/strong\u003e \u003cstrong\u003e12 ≤ HVPG \u0026lt; 16 mmHg; C:\u003c/strong\u003e \u003cstrong\u003e16 ≤ HVPG \u0026lt; 20 mmHg; D: 20 ≤ HVPG \u0026lt; 24 mmHg; E: HVPG ≥ 24 mmHg. WHVP: wedged hepatic venous pressure; PVP: portal venous pressure; HVPG: hepatic venous pressure gradient.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4597526/v1/53cff25e76cfd74918262a6f.jpg"},{"id":60594324,"identity":"8caedf3e-008d-4eed-b9a3-c154ef2a94ea","added_by":"auto","created_at":"2024-07-18 15:21:48","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":48798,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComparison between WHVP and PVP using the Wilcoxon signed-rank test. ****: P \u0026lt; 0.0001; ns: no significance.\u003c/strong\u003e \u003cstrong\u003eA: HVPG \u0026lt; 12 mmHg; B: 12 ≤ HVPG \u0026lt; 16 mmHg; C: 16 ≤ HVPG \u0026lt; 20 mmHg; D: 20 ≤ HVPG \u0026lt; 24 mmHg; E: HVPG ≥ 24 mmHg. WHVP: wedged hepatic venous pressure.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4597526/v1/8638be5061370d7e66b8d915.jpg"},{"id":70381738,"identity":"43ade2e9-581f-4f3b-b444-9155f0f1fa7a","added_by":"auto","created_at":"2024-12-02 16:14:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1099088,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4597526/v1/5928693e-33d9-4750-a546-5df043549d4d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Stratified Analysis of the Correlation between Wedged Hepatic Venous Pressure and Portal Venous Pressure in Patients with Portal Hypertension: A Multicenter Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePortal hypertension (PHT) is one of the most common and severe complications of cirrhosis, affecting millions of patients worldwide and significantly impacting their quality of life and survival rates\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. It typically signifies the progression of liver disease to an advanced stage, necessitating active monitoring and management. The clinical manifestations of PHT include gastrointestinal bleeding, ascites, and hepatic encephalopathy, making accurate assessment of portal venous pressure (PVP) crucial for the prevention and treatment of high-risk patients\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eTraditional methods of measuring PVP are highly invasive and carry significant risks, making noninvasive assessment techniques, such as the estimation of PVP from wedged hepatic venous pressure (WHVP), critical in clinical practice. To mitigate the influence of ascites or intra-abdominal pressure, which may artificially elevate WHVP, the hepatic venous pressure gradient (HVPG), the discrepancy between WHVP and the free hepatic vein pressure (FHVP), is often measured\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. The consistency between WHVP and PVP is a pivotal factor in the assessment of PHT, and its accuracy directly correlates with the diagnosis and subsequent treatment of PHT\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eWHVP has been correlated with PVP, but these investigations often overlooked the diversity of etiologies and the potential impact of disease progression on this relationship\u003csup\u003e[\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. Moreover, our understanding of how HVPG affects the concordance between WHVP and PVP is superficial. HVPG\u0026thinsp;\u0026ge;\u0026thinsp;12 mmHg can indicate cirrhosis and PHT decompensation\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. A measurement error of HVPG\u0026thinsp;\u0026gt;\u0026thinsp;4 mmHg can seriously affect the judgment of clinical results and the choice of treatment\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. On this foundation, the present study stratified HVPG and explored the consistency between WHVP and PVP in different HVPG strata using a large-scale, multicenter approach. Our aim is to provide a more accurate PHT assessment method for clinicians, thereby improving the treatment outcomes and prognosis of patients with PHT.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatients\u003c/h2\u003e \u003cp\u003eThis retrospective study analyzed patients who underwent transjugular intrahepatic portosystemic shunt (TIPS) surgery at three different Beijing hospitals that have extensive experience in TIPS procedures and venous pressure measurements in Beijing Shijitan Hospital, Beijing You\u0026rsquo;an Hospital and the Fifth Medical Center of Chinese People's Liberation Army General Hospital (302 Hospital) between January 2020 and June 2023. The study included 785 patients with PHT (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Inclusion criteria: patients aged 18 years or older with a confirmed diagnosis of PHT who were scheduled for TIPS treatment, in whom WHVP and PVP were successfully measured intraoperatively. Exclusion criteria: history of malignant hepatobiliary system tumors, occlusive portal vein thrombosis, previous history of hepatic transplantation, recent use of drugs affecting portal vein pressure, and severe cardiopulmonary disease. The study was carried out in compliance with the relevant guidelines and the Declaration of Helsinki, having received approval from the ethical committees of the participating hospitals. Informed consent was obtained from all patients.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eMeasurement of WHVP and PVP\u003c/h2\u003e \u003cp\u003ePreoperative preparation\u003c/p\u003e \u003cp\u003e(1) All patients stopped taking drugs that affect portal vein pressure for at least 1 week before surgery. (2) They underwent relevant laboratory tests, including complete blood count, coagulation function, liver and kidney function, electrolytes, ammonia levels, blood type, and indocyanine green retention rate at 15 minutes (a quantitative liver function testICG-R15). (3) They underwent an electrocardiogram, echocardiography, and chest X-ray in both anterior-posterior and lateral views to exclude severe cardiopulmonary diseases. (4) They underwent ultrasound of the portal vein, enhanced abdominal CT and MRI to clarify the conditions of the hepatic veins, portal vein, and its branches. (5) We informed the patient and the patient\u0026rsquo;s family about the patient's condition, the expected outcomes of the procedure, the potential risks as documented, and alternative options in case of those risks. Every willing participant signed an informed consent agreement for the procedure.\u003c/p\u003e \u003cp\u003ePressure measurement\u003c/p\u003e \u003cp\u003eThe measurements were performed by experienced interventional radiologists according to a standard protocol\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. After disinfection and local anesthesia, a catheter sheath was introduced into the right internal jugular vein, and pressure within the right atrium and inferior vena cava was measured using the RUPS-100 system (COOK Medical, USA). After confirming venous patency with hepatic venography, a Fogarty balloon catheter (Edwards Lifesciences, USA) connected to a pressure sensor was inserted into the hepatic vein via a 10 F sheath for pressure assessment. FHVP and WHVP were determined by positioning the balloon catheter tip 3\u0026ndash;5 cm from the inferior vena cava and achieving complete venous occlusion (5 ml of contrast medium was injected for hepatic venography to confirm the absence of contrast reflux and venous collateral flow). The measurements were adjusted for occlusion adequacy and were done three times for accuracy. Under fluoroscopic guidance, the hepatic vein was punctured into the portal vein, and PVP and inferior vena cava pressure (IVCP) were measured by advancing a pigtail catheter into the splenic vein or superior mesenteric vein. This procedure was performed three times to calculate the average pressure values. HVPG was calculated as WHVP minus FHVP, and the portal pressure gradient (PPG) was calculated as PVP minus IVCP\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e, after which we did the TIPS procedure.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eGroups and definitions\u003c/h2\u003e \u003cp\u003ePatients were divided into 5 groups according to their HVPG values. Patients with HVPG\u0026thinsp;\u0026le;\u0026thinsp;12 mmHg were defined as group A, patients with 12\u0026thinsp;\u0026lt;\u0026thinsp;HVPG\u0026thinsp;\u0026le;\u0026thinsp;16 mmHg were defined as group B, patients with 16\u0026thinsp;\u0026lt;\u0026thinsp;HVPG\u0026thinsp;\u0026le;\u0026thinsp;20 mmHg were defined as group C, and patients with 20\u0026thinsp;\u0026lt;\u0026thinsp;HVPG\u0026thinsp;\u0026le;\u0026thinsp;24 mmHg were defined as group D, and patients with HVPG\u0026thinsp;\u0026ge;\u0026thinsp;24 mmHg were defined as group E.\u003c/p\u003e \u003cp\u003eWHVP and PVP were defined as in agreement when both pressures differed by \u0026le;\u0026thinsp;10% of the PVP value. WHVP and PVP were in disagreement when both pressures differed by \u0026gt;\u0026thinsp;10% of the PVP value\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. WHVP was defined as underestimating PVP when WHVP was more than 10% lower than PVP. WHVP was defined as overestimating PVP when WHVP was more than 10% higher than PVP\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eSPSS 25.0 (SPSS, Inc., Chicago, IL, USA) and GraphPad Prism 9 (GraphPad, Inc., San Diego, CA, USA) were used for statistical analysis and graphing. Continuous variables with a normal or near-normal distribution are reported as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, and nonnormally distributed variables are reported as median [interquartile range, IQR]. The chi-squared test or Fisher\u0026rsquo;s exact test was used to compare groups on categorical variables, while Student\u0026rsquo;s t test or the Mann‒Whitney U test was used for continuous ones. Within-group differences between WHVP and PVP were examined using the paired t test or Wilcoxon signed-rank test, as appropriate. WHVP\u0026ndash;PVP agreement was assessed via Pearson\u0026rsquo;s correlation coefficient (R), the intraclass correlation coefficient (ICC), and Bland‒Altman analysis. A higher ICC and R along with narrower Bland‒Altman 95% limits of agreement (95% LoA, mean difference\u0026thinsp;\u0026plusmn;\u0026thinsp;1.96 standard deviation) indicated better consistency\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 meant a difference was statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eBaseline characteristics\u003c/h2\u003e\n \u003cp\u003eIn this study, a cohort of 785 patients with PHT who met the inclusion criteria was recruited from three centers. The cohort comprised 538 males (68.5%) and 247 females (31.5%), with an age distribution ranging from 18 to 80 years and a mean age of 53\u0026thinsp;\u0026plusmn;\u0026thinsp;12 years. The etiology of PHT was categorized as follows: hepatitis B virus-related cirrhosis in 351 cases, hepatitis C virus-related cirrhosis in 42 cases, alcoholic cirrhosis in 95 cases, autoimmune liver diseases in 88 cases, hepatic veno-occlusive disease/hepatic sinusoidal obstruction syndrome in 90 cases, drug-induced liver injury in 18 cases, idiopathic PHT in 61 cases, and cryptogenic cirrhosis in 40 cases. Among the participants, 617 patients (78.6%) presented with gastrointestinal bleeding, 77 patients (9.8%) with refractory ascites/hydrothorax, and 91 patients (11.6%) with gastrointestinal bleeding combined with refractory ascites. All patients successfully underwent pressure measurements and the TIPS procedure without any surgery-related complications or deaths. From their HVPG measurements, the patients were stratified into five groups: group A with HVPG\u0026thinsp;\u0026lt;\u0026thinsp;12 mmHg (258 patients, 32.9%), group B with 12\u0026thinsp;\u0026le;\u0026thinsp;HVPG\u0026thinsp;\u0026lt;\u0026thinsp;16 mmHg (104 patients, 13.2%), group C with 16\u0026thinsp;\u0026le;\u0026thinsp;HVPG\u0026thinsp;\u0026lt;\u0026thinsp;20 mmHg (141 patients, 18.0%), group D with 20\u0026thinsp;\u0026le;\u0026thinsp;HVPG\u0026thinsp;\u0026lt;\u0026thinsp;24 mmHg (113 patients, 14.4%), and group E with HVPG\u0026thinsp;\u0026ge;\u0026thinsp;24 mmHg (169 patients, 21.5%). Patient demographics and baseline characteristics are detailed in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBaseline characteristics of the included patients.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"10\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eParameters\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup A\u003c/p\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;258\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup B\u003c/p\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;104\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup C\u003c/p\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;141\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup D\u003c/p\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;113\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup E\u003c/p\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;169\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSex (male)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e167\u003c/p\u003e\n \u003cp\u003e(64.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003cp\u003e(62.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e103\u003c/p\u003e\n \u003cp\u003e(73.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003cp\u003e(74.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e119\u003c/p\u003e\n \u003cp\u003e(70.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e51.8\u0026thinsp;\u0026plusmn;\u0026thinsp;12.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e54.6\u0026thinsp;\u0026plusmn;\u0026thinsp;12.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e53.1\u0026thinsp;\u0026plusmn;\u0026thinsp;12.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e53.9\u0026thinsp;\u0026plusmn;\u0026thinsp;12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e53.2\u0026thinsp;\u0026plusmn;\u0026thinsp;12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEtiology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHBV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e106 (41.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e48 (46.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e63 (44.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e52 (46.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e82 (48.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHCV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7 (2.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4 (3.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9 (8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eALC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32 (12.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10 (9.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19 (13.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12 (10.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22 (13.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eALD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28 (10.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16 (15.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16 (11.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14 (12.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14 (8.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDILI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8 (3.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3 (2.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2 (1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1 (0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4 (2.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHVOD/HSOS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35 (13.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12 (11.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15 (10.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11 (9.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17 (10.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIPH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30 (11.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9 (6.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6 (5.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11 (6.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12 (4.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6 (5.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7 (5.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7 (4.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIndication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVariceal bleeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e208 (80.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e80 (76.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e115 (81.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e87 (77.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e127 (75.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAscites\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25 (9.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11 (10.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11 (7.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16 (14.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14 (8.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBoth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25 (9.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13 (12.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15 (10.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10 (8.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28 (16.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLaboratory values\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eALT (U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.0 (13.0\u0026ndash;29.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18.5 (14.0-30.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.0 (13.0\u0026ndash;27.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21.5 (15.0\u0026ndash;31.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.0 (15.0\u0026ndash;27.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAST (U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25.0 (20.0\u0026ndash;35.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28.5 (23.0\u0026ndash;42.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26.0 (20.0-36.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30.0 (22.0-44.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e29.5 (23.0\u0026ndash;43.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eALP (U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e89.0 (68.0-128.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e91.0 (64.3\u0026ndash;141.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e80.0 (60.5-112.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e84.0 (61.0-116.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e92.5 (70.0-124.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGGT (U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e37.0 (20.0\u0026ndash;59.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40.0 (19.0-77.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35.0 (16.0-72.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39.5 (18.0-83.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41.5 (21.3\u0026ndash;93.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eALB (g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36.9\u0026thinsp;\u0026plusmn;\u0026thinsp;4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35.5\u0026thinsp;\u0026plusmn;\u0026thinsp;5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCr (\u0026micro;mol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e61.0 (52.0\u0026ndash;69.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e65.0 (51.3\u0026ndash;75.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e62.0 (51.5\u0026ndash;76.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e62.0 (51.0\u0026ndash;73.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e62.0 (51.0\u0026ndash;74.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTB (\u0026micro;mol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21.5 (14.3\u0026ndash;30.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21.4 (16.5\u0026ndash;33.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22.7 (16.0-32.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27.1 (17.0-38.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25.2 (17.3\u0026ndash;39.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eINR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.2 (1.1\u0026ndash;1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.3 (1.2\u0026ndash;1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.3 (1.2\u0026ndash;1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.3 (1.2\u0026ndash;1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.3 (1.2\u0026ndash;1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAPTT (s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32.7 (30.1\u0026ndash;35.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32.6 (30.7\u0026ndash;35.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32.5 (30.3\u0026ndash;36.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33.4 (31.4\u0026ndash;37.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33.6 (31.0-37.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePT (s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.6 (12.4\u0026ndash;15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.8 (12.7\u0026ndash;15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.5 (13.3\u0026ndash;16.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.5 (12.8\u0026ndash;16.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.4 (13.3\u0026ndash;16.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHb (g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e96.4\u0026thinsp;\u0026plusmn;\u0026thinsp;26.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e94.9\u0026thinsp;\u0026plusmn;\u0026thinsp;26.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e88.5\u0026thinsp;\u0026plusmn;\u0026thinsp;26.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e94.7\u0026thinsp;\u0026plusmn;\u0026thinsp;24.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e90.6\u0026thinsp;\u0026plusmn;\u0026thinsp;23.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWBC (\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.0 (2.0-4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.8 (1.8\u0026ndash;4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.9 (1.7\u0026ndash;4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.9 (1.9\u0026ndash;4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.8 (1.9\u0026ndash;4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePLT (\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e89.0 (51.0-163.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e77.5 (51.0-113.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e75.0 (52.0-107.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e76.5 (50.0-118.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e74.0 (51.3\u0026ndash;112.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChild‒Pugh score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.0 (5.0\u0026ndash;7.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.0 (6.0\u0026ndash;7.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.0 (6.0\u0026ndash;8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.0 (6.0\u0026ndash;8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.0 (6.0\u0026ndash;8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHemodynamics (mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWHVP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17.9\u0026thinsp;\u0026plusmn;\u0026thinsp;6.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24.7\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32.9\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39.0\u0026thinsp;\u0026plusmn;\u0026thinsp;6.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePVP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32.9\u0026thinsp;\u0026plusmn;\u0026thinsp;7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33.5\u0026thinsp;\u0026plusmn;\u0026thinsp;7.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33.1\u0026thinsp;\u0026plusmn;\u0026thinsp;6.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33.5\u0026thinsp;\u0026plusmn;\u0026thinsp;6.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34.9\u0026thinsp;\u0026plusmn;\u0026thinsp;6.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFHVP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.9\u0026thinsp;\u0026plusmn;\u0026thinsp;4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIVCP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHVPG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePPG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24.7\u0026thinsp;\u0026plusmn;\u0026thinsp;6.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25.5\u0026thinsp;\u0026plusmn;\u0026thinsp;7.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25.2\u0026thinsp;\u0026plusmn;\u0026thinsp;6.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25.5\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26.6\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\"\u003eHBV: hepatitis B virus\u0026ndash;related cirrhosis; HCV: hepatitis C virus\u0026ndash;related cirrhosis; ALC: alcoholic liver cirrhosis; ALD: autoimmune liver disease; DILI: drug-induced liver injury; HVOD: hepatic veno-occlusive disease; HSOS: hepatic sinusoidal obstruction syndrome; IPH: idiopathic portal hypertension; Other: liver cirrhosis of unknown cause; ALT: alanine aminotransferase; AST: aspartate aminotransferase; ALP: alkaline phosphatase; GGT: \u0026gamma;-glutamyl transpeptidase; ALB: albumin; TB: total bilirubin; INR: international normalized ratio; APTT: activated partial thromboplastin time; PT: prothrombin time; Hb: hemoglobin; WBC: white blood cell; PLT: platelet; WHVP: wedged hepatic venous pressure; PVP: portal venous pressure; FHVP: free hepatic venous pressure; IVCP: inferior vena cava pressure; HVPG: hepatic venous pressure gradient; PPG: portal venous pressure gradient.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003ch2\u003eAgreement analysis between WHVP and PVP\u003c/h2\u003e\n \u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e displays the Pearson\u0026rsquo;s R, ICC, and 95%LoA for WHVP and PVP across the different groups. Group D, (20\u0026thinsp;\u0026le;\u0026thinsp;HVPG\u0026thinsp;\u0026lt;\u0026thinsp;24 mmHg) exhibited the strongest correlation between WHVP and PVP (R\u0026thinsp;=\u0026thinsp;0.52, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and highest ICC (ICC\u0026thinsp;=\u0026thinsp;0.66, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), suggesting that the best concordance between WHVP and PVP was within this range. This R and ICC indicated moderate agreement. The R and ICC values in the other groups were as follows: group A: R\u0026thinsp;=\u0026thinsp;0.27 (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), ICC\u0026thinsp;=\u0026thinsp;0.14 (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001); group B: R\u0026thinsp;=\u0026thinsp;0.21 (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.036), ICC\u0026thinsp;=\u0026thinsp;0.16 (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.03); group C: R\u0026thinsp;=\u0026thinsp;0.35 (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), ICC\u0026thinsp;=\u0026thinsp;0.35 (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001); and group E: R\u0026thinsp;=\u0026thinsp;0.31 (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), ICC\u0026thinsp;=\u0026thinsp;0.42 (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). These four strata all showed poor agreement between WHVP and PVP.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCorrelations between wedged hepatic venous pressure and portal venous pressure.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eICC\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP value\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e95%LoA\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup A\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eHVPG\u0026thinsp;\u0026lt;\u0026thinsp;12 mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.77\u0026ndash;15.64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup B\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e12\u0026thinsp;\u0026le;\u0026thinsp;HVPG\u0026thinsp;\u0026lt;\u0026thinsp;16 mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.39\u0026ndash;15.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup C\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e16\u0026thinsp;\u0026le;\u0026thinsp;HVPG\u0026thinsp;\u0026lt;\u0026thinsp;20 mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.12\u0026ndash;14.68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup D\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e20\u0026thinsp;\u0026le;\u0026thinsp;HVPG\u0026thinsp;\u0026lt;\u0026thinsp;24 mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.78\u0026ndash;14.30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup E\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eHVPG\u0026thinsp;\u0026ge;\u0026thinsp;24 mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.38\u0026ndash;15.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003eHVPG: hepatic venous pressure gradient; R: Pearson\u0026rsquo;s correlation coefficient; ICC: interclass correlation coefficient; 95%LoA: 95% limits of agreement (mean difference\u0026thinsp;\u0026plusmn;\u0026thinsp;1.96 standard deviation).\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eWhen assessing the concordance between WHVP and PVP using Bland‒Altman analysis, a wider 95% LoA suggested poorer agreement. Correspondingly, as revealed in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e, group D\u0026apos;s WHVP and PVP (Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e) had the narrowest 95% LoA, indicating the best concordance. Group B had the widest 95% LoA, signifying the poorest agreement. These findings align with the results from the Pearson correlation analysis.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003ePerformance of WHVP in evaluating PVP\u003c/h2\u003e\n \u003cp\u003eThe mean values of WHVP and PVP across the different groups are presented in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. In group A, the average WHVP was approximately 15 mmHg lower than the average PVP, a significant difference (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In group B, the average WHVP was around 9 mmHg lower than the average PVP (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In group C, the average WHVP was about 5 mmHg lower than the average PVP (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Group D exhibited the closest mean values between WHVP and PVP, with a difference of less than 1 mmHg, which were not statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.196). In group E, the average WHVP was approximately 4 mmHg higher than the average PVP (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The comparisons between WHVP and PVP across the groups are depicted in Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\n \u003cp\u003eAs indicated in Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e, more patients in group D had WHVP\u0026ndash;PVP agreement (difference\u0026thinsp;\u0026le;\u0026thinsp;10% PVP) than any other group, at 48.7%, whereas group A had the highest proportion of disagreement (difference\u0026thinsp;\u0026gt;\u0026thinsp;10% PVP), at 95.3%. By integrating the data from Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e with Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e, we saw that among patients whose WHVP was lower than their PVP, 93.8% were from group A. This suggests that when HVPG is \u0026lt;\u0026thinsp;12 mmHg, WHVP often underestimates PVP. As the pressures gradually increased, the concordance between WHVP and PVP also increases till it reached its maximum in group D. Moreover, among patients whose WHVP was greater than their PVP, the largest proportion was found in group E, at 48.5%, indicating that when HVPG is \u0026ge;\u0026thinsp;24 mmHg, WHVP often overestimates PVP (the differences were statistically significant after applying Bonferroni correction for multiple comparisons).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ePerformance of wedged hepatic venous pressure in assessing portal venous pressure.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"12\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup A\u003c/p\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;258\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup B\u003c/p\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;104\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup C\u003c/p\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;141\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup D\u003c/p\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;113\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup E\u003c/p\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;169\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP value\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAgreement between\u003c/p\u003e\n \u003cp\u003eWHVP and PVP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003cp\u003e(4.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003cp\u003e(24.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003cp\u003e(34.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003cp\u003e(48.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003cp\u003e(42.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDisagreement between\u003c/p\u003e\n \u003cp\u003eWHVP and PVP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e246\u003c/p\u003e\n \u003cp\u003e(95.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003cp\u003e(76.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003cp\u003e(66.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003cp\u003e(51.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003cp\u003e(58.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnderestimation of PVP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e242\u003c/p\u003e\n \u003cp\u003e(93.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003cp\u003e(74.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003cp\u003e(54.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003cp\u003e(27.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003cp\u003e(9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOverestimation of PVP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003cp\u003e(1.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003cp\u003e(2.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003cp\u003e(11.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003cp\u003e(23.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003cp\u003e(48.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\"\u003eWHVP: wedged hepatic venous pressure; PVP: portal venous pressure\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eHVPG is the most commonly used clinical parameter for assessing sinusoidal PHT in patients with cirrhosis, serving as the gold standard for identifying the presence of clinically significant PHT (defined as HVPG\u0026thinsp;\u0026ge;\u0026thinsp;10 mmHg)\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. Stratified management of HVPG plays a pivotal role in disease prognostic assessment\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e, monitoring therapeutic responses\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e, predicting complications\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e, and guiding liver transplantation decisions\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. WHVP is a key variable in calculating HVPG, and accurately reflecting PVP is a prerequisite for the HVPG-based diagnosis of PHT. Although numerous studies\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e have indicated that the correlation between WHVP and PVP is influenced by various factors, such as etiology and hepatic vascular anatomy, research integrating their relationship with HVPG stratification remains scarce. In this study, we conducted a multicenter analysis of HVPG strata to investigate the various correlations between WHVP and PVP. Through a detailed analysis of 785 patients, we found the significant impact of HVPG on the concordance between WHVP and PVP, providing important insights for the optimization of management and treatment strategies for PHT.\u003c/p\u003e \u003cp\u003eOur study indicates that the overall correlation between WHVP and PVP is relatively weak, which may be attributed to our inclusion of patients with various etiologies of PHT, such as cryptogenic cirrhosis, hepatic veno-occlusive disease/hepatic sinusoidal obstruction syndrome, leading to nonsinusoidal PHT. Our work is the first to demonstrate that the concordance between WHVP and PVP varies with changes in HVPG. The best concordance was in group D (HVPG between 20 and 24 mmHg) and the worst in group A (HVPG\u0026thinsp;\u0026lt;\u0026thinsp;12 mmHg). We set a threshold for concordance at 10% of the magnitude of PVP, calling WHVP and PVP discordant when their difference passed this threshold, in which case WHVP did not accurately reflect PVP. Accordingly, we found that the highest proportion of patients had HVPG\u0026thinsp;\u0026lt;\u0026thinsp;12 mmHg (95.3%), and the lowest proportion had an HVPG in the 20\u0026thinsp;~\u0026thinsp;24 mmHg range (51.3%), providing an important reference standard for clinical assessment. Clinically, for patients undergoing secondary prevention, HVPG\u0026thinsp;\u0026lt;\u0026thinsp;12 mmHg or a reduction of 20% from baseline indicates a decreased probability of rebleeding\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. For such patients, a comprehensive assessment incorporating clinical symptoms and laboratory tests should be conducted to make an accurate judgment on secondary prevention.\u003c/p\u003e \u003cp\u003eOur study further revealed that when HVPG is \u0026lt;\u0026thinsp;12 mmHg, WHVP often underestimates PVP, which may be related to the presence of anatomical shunting in hepatic vessels and changes in hepatic hemodynamics. Extensive research by our group\u003csup\u003e[\u003cspan additionalcitationids=\"CR25 CR26\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e has indicated that the presence of hepatic venous collaterals is a key factor contributing to the underestimation of PPG by HVPG. Specifically, when the hepatic vein is occluded with a balloon to measure WHVP, the presence of collaterals allows a portion of the hepatic venous blood flow to return to the systemic circulation through these collaterals, resulting in a lower measured pressure. Therefore, in conjunction with the findings of this study, we can infer that the lower the HVPG is, the more pronounced the underestimation of PVP by WHVP becomes, suggesting that at this point, diversion through collaterals plays a dominant role. One study\u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e has shown that the underestimation of PVP by WHVP could be attributed to presinusoidal PHT, yet the underlying pathophysiological mechanisms remain unclear. Whether these patients with presinusoidal PHT predominantly have HVPG\u0026thinsp;\u0026lt;\u0026thinsp;12 mmHg warrants further investigation.\u003c/p\u003e \u003cp\u003eWHVP often overestimated PVP in group E (HVPG\u0026thinsp;\u0026ge;\u0026thinsp;24 mmHg), which may be associated with their abnormal perfusion of hepatic blood flow. Our previous studies \u003csup\u003e[\u003cspan additionalcitationids=\"CR25 CR26\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e indicated that the absence of collaterals between hepatic veins and between hepatic and portal veins could lead HVPG to overestimate PPG. In such scenarios, the blood flow and sinusoidal pressure in the liver might depend mostly on hepatic arterial perfusion, possibly even resulting in a reversal of the direction of portal vein blood flow. The findings of the current study suggest that the higher the HVPG is, particularly above 24 mmHg, the more pronounced the overestimation of PVP becomes, indicating that the blood supply to the sinusoids may come mostly from the hepatic artery under these conditions. Other studies have shown that an WHVP often overestimates PVP when the PHT includes a postsinusoidal component\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. This may be related to the presence of reversed hepatic blood flow, the opening of paraumbilical veins, and the formation of portocaval anastomoses. Whether this phenomenon of postsinusoidal PHT occurs more in patients with HVPG\u0026thinsp;\u0026ge;\u0026thinsp;24 mmHg requires further research.\u003c/p\u003e \u003cp\u003eDespite the valuable insights provided by our study, it has some limitations. First, it did not delve into the physiological mechanisms underlying the discrepancies in concordance between WHVP and PVP. This will be an important direction for future research. Second, although the patients had a wide range of etiologies of PHT, the these causes might not have been subdivided finely enough. Specific etiologies, such as hepatitis B virus, hepatitis C virus, and alcoholic liver disease, may have different impacts on the physiological effects of PHT and thus on the concordance between WHVP and PVP. The failure to finely distinguish these causes may obscure the impact of etiology-specific factors. Future research should aim to overcome these limitations, enhancing the generalizability of the results, through multicentric and international collaborative studies.\u003c/p\u003e \u003cp\u003eIn summary, through a large-scale, multicentric design, this study conducted an in-depth analysis of the concordance between WHVP and PVP in patients with PHT and revealed the impact of HVPG on their concordance. These findings underscore the importance of considering HVPG when evaluating patients with PHT, as well as the necessity of identifying potential discrepancies between WHVP and PVP when formulating treatment strategies. Despite certain limitations, our research provides valuable information and new directions for future clinical practice, which we hope will help optimize management strategies for PHT and improve patient outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eHVPG: hepatic venous pressure gradient; ICC: intraclass correlation coefficient; PHT: portal hypertension; PVP: portal venous pressure; R: Pearson\u0026rsquo;s correlation coefficient; WHVP: wedged hepatic venous pressure.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to express our gratitude to all the medical staff of the Liver disease Minimally Invasive Diagnosis and Treatment Center of Beijing Shijitan Hospital affiliated to Capital Medical University, Liver Vascular disease Diagnosis and Treatment Center of Fifth Medical Center of Chinese PLA General Hospital and Department of Gastroenterology and Hepatology of Beijing You\u0026apos;an Hospital affiliated to Capital Medical University for assisting in the collection of clinical data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data underlying this article will be shared on reasonable request to the corresponding author.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e The study was supported by the Talent Training Plan during the \u0026quot;14th Five-Year Plan\u0026quot; period of Beijing Shijitan Hospital affiliated to Capital Medical University (2023LJRCLFQ) and National Multi-Center Clinical Research Project of Peking University First Hospital (2022cz020301) to Fuquan Liu.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicting interests:\u003c/strong\u003e The authors declare that they have no conflict of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure of Ethical Statements:\u003c/strong\u003e The study was approved by the Ethics Committee and Institutional Review Board of Beijing Shijitan Hospital, Beijing\u0026nbsp;You\u0026apos;an Hospital and the Fifth Medical Center of Chinese PLA General Hospital.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u0026nbsp;\u003c/strong\u003eFuquan Liu, Yongping Yang and Huiguo Ding designed the research; Bing Zhu, Dongze Li, Hua Tian, Shaoli You, Fuchuan Wang, Sa Lv, Yifan Wu, Chengbin Dong and Yu Zhang performed the research; Yifan Lv analyzed the data and wrote the paper; Fuquan Liu reviewed and edited the manuscript. All authors read and approved the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSAAB S. Portal Hypertension [J]. Clin Liver Dis, 2019, 23(4): xiii-xiv.\u003c/li\u003e\n\u003cli\u003eSIMONETTO D A, LIU M, KAMATH P S. Portal Hypertension and Related Complications: Diagnosis and Management [J]. Mayo Clin Proc, 2019, 94(4): 714-26.\u003c/li\u003e\n\u003cli\u003eTURCO L, GARCIA-TSAO G. Portal Hypertension: Pathogenesis and Diagnosis [J]. Clin Liver Dis, 2019, 23(4): 573-87.\u003c/li\u003e\n\u003cli\u003eKUMAR A, SHARMA P, SARIN S K. Hepatic venous pressure gradient measurement: time to learn! [J]. Indian J Gastroenterol, 2008, 27(2): 74-80.\u003c/li\u003e\n\u003cli\u003eBOCHNAKOVA T. Hepatic Venous Pressure Gradient [J]. Clin Liver Dis (Hoboken), 2021, 17(3): 144-8.\u003c/li\u003e\n\u003cli\u003eBAZARBASHI A N, RYOU M. Portal pressure measurement: Have we come full circle? [J]. Gastrointest Endosc, 2021, 93(3): 573-6.\u003c/li\u003e\n\u003cli\u003eGROSZMANN R J, WONGCHARATRAWEE S. The hepatic venous pressure gradient: anything worth doing should be done right [J]. Hepatology, 2004, 39(2): 280-2.\u003c/li\u003e\n\u003cli\u003eCHENG Y, GU L, YIN X, et al. Agreement between Wedged Hepatic Venous Pressure and Portal Pressure in Hepatic Sinusoidal Obstruction Syndrome [J]. J Pers Med, 2022, 13(1).\u003c/li\u003e\n\u003cli\u003eFERRUSQUIA-ACOSTA J, BASSEGODA O, TURCO L, et al. Agreement between wedged hepatic venous pressure and portal pressure in non-alcoholic steatohepatitis-related cirrhosis [J]. J Hepatol, 2021, 74(4): 811-8.\u003c/li\u003e\n\u003cli\u003ePERELLO A, ESCORSELL A, BRU C, et al. Wedged hepatic venous pressure adequately reflects portal pressure in hepatitis C virus-related cirrhosis [J]. Hepatology, 1999, 30(6): 1393-7.\u003c/li\u003e\n\u003cli\u003eVELDHUIJZEN VAN ZANTEN D, BUGANZA E, ABRALDES J G. The Role of Hepatic Venous Pressure Gradient in the Management of Cirrhosis [J]. Clin Liver Dis, 2021, 25(2): 327-43.\u003c/li\u003e\n\u003cli\u003eMA J, GONG X, LUO J, et al. Impact of Intrahepatic Venovenous Shunt on Hepatic Venous Pressure Gradient Measurement [J]. J Vasc Interv Radiol, 2020, 31(12): 2081-8.\u003c/li\u003e\n\u003cli\u003eALLIANCE C P H, GROUP M I I C. Consensus on clinical application of hepatic venous pressure gradient in China (2023 edition) [J]. Zhonghua yi xue za zhi, 2023, 103(48): 3885-95.\u003c/li\u003e\n\u003cli\u003eBOSCH J, ABRALDES J G, BERZIGOTTI A, GARCIA-PAGAN J C. The clinical use of HVPG measurements in chronic liver disease [J]. Nat Rev Gastroenterol Hepatol, 2009, 6(10): 573-82.\u003c/li\u003e\n\u003cli\u003eBLAND J M, ALTMAN D G. Statistical methods for assessing agreement between two methods of clinical measurement [J]. Lancet, 1986, 1(8476): 307-10.\u003c/li\u003e\n\u003cli\u003eDE FRANCHIS R, BOSCH J, GARCIA-TSAO G, et al. Baveno VII - Renewing consensus in portal hypertension [J]. J Hepatol, 2022, 76(4): 959-74.\u003c/li\u003e\n\u003cli\u003ePATERNOSTRO R, BECKER J, HOFER B S, et al. The prognostic value of HVPG-response to non-selective beta-blockers in patients with NASH cirrhosis and varices [J]. Dig Liver Dis, 2022, 54(4): 500-8.\u003c/li\u003e\n\u003cli\u003eALBILLOS A, BANARES R, GONZALEZ M, et al. Value of the hepatic venous pressure gradient to monitor drug therapy for portal hypertension: a meta-analysis [J]. Am J Gastroenterol, 2007, 102(5): 1116-26.\u003c/li\u003e\n\u003cli\u003eLA MURA V, GARCIA-GUIX M, BERZIGOTTI A, et al. A Prognostic Strategy Based on Stage of Cirrhosis and HVPG to Improve Risk Stratification After Variceal Bleeding [J]. Hepatology, 2020, 72(4): 1353-65.\u003c/li\u003e\n\u003cli\u003eGIABICANI M, JOLY P, SIGAUT S, et al. Predictive Role of Hepatic Venous Pressure Gradient in Bleeding Events Among Cirrhotic Patients Undergoing Orthotopic Liver Transplantation [J]. JHEP Reports, 2024: 101051.\u003c/li\u003e\n\u003cli\u003eOSADA Y, KANAZAWA H, NARAHARA Y, et al. Wedged hepatic venous pressure does not reflect portal pressure in patients with cirrhosis and hepatic veno-venous communications [J]. Dig Dis Sci, 2008, 53(1): 7-13.\u003c/li\u003e\n\u003cli\u003ePOMIER-LAYRARGUES G, KUSIELEWICZ D, WILLEMS B, et al. Presinusoidal portal hypertension in non-alcoholic cirrhosis [J]. Hepatology, 1985, 5(3): 415-8.\u003c/li\u003e\n\u003cli\u003eBAIGES A, HERNANDEZ-GEA V, BOSCH J. Pharmacologic prevention of variceal bleeding and rebleeding [J]. Hepatol Int, 2018, 12(Suppl 1): 68-80.\u003c/li\u003e\n\u003cli\u003eLIU B, ZHANG D, DONG C, et al. Correlation between hepatic venous pressure gradient and portal pressure gradient in patients with autoimmune cirrhotic portal hypertension and collateral branches of the hepatic vein [J]. Hepatol Res, 2023, 53(11): 1084-95.\u003c/li\u003e\n\u003cli\u003eLV Y, SONG Q, YUE Z, et al. Correlation between hepatic venous pressure gradient and portal venous pressure gradient in hepatitis B cirrhosis with different hepatic veins anatomy [J]. Eur J Radiol, 2022, 155: 110463.\u003c/li\u003e\n\u003cli\u003eZHANG D, WANG T, YUE Z D, et al. Hepatic venous pressure gradient: Inaccurately estimates portal venous pressure gradient in alcoholic cirrhosis and portal hypertension [J]. World J Gastrointest Surg, 2023, 15(11): 2490-9.\u003c/li\u003e\n\u003cli\u003eWANG L, SONG Q K, YUE Z D, et al. [Study on the correlation between PPG and HVPG in patients with portal hypertension] [J]. Zhonghua Gan Zang Bing Za Zhi, 2022, 30(7): 722-7.\u003c/li\u003e\n\u003cli\u003eMADIR A, GRGUREVIC I, TSOCHATZIS E A, PINZANI M. Portal hypertension in patients with nonalcoholic fatty liver disease: Current knowledge and challenges [J]. World J Gastroenterol, 2024, 30(4): 290-307.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"wedged hepatic venous pressure, portal venous pressure, hepatic venous pressure gradient, stratified analysis, portal hypertension","lastPublishedDoi":"10.21203/rs.3.rs-4597526/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4597526/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eAim:\u003c/strong\u003e To evaluate the differences in the agreement between wedged hepatic venous pressure (WHVP) and portal venous pressure (PVP) at different hepatic venous pressure gradient (HVPG) levels to provide new guidance for the clinical diagnosis and management of portal hypertension (PHT).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A multicenter study of 785 patients with PHT from three centers was stratified into five groups by their HVPG: \u0026lt;12 (group A), 12 ≤ HVPG \u0026lt; 16 mmHg (group B), 16 ≤ HVPG \u0026lt; 20 mmHg (group C), 20 ≤ HVPG \u0026lt; 24 mmHg (group D), ≥24 mmHg (group E). Concordance was analyzed using Pearson’s correlation coefficient (R), the intraclass correlation coefficient (ICC), and Bland‒Altman analysis in each HVPG stratum.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Correlation and agreement between WHVP and PVP varied by HVPG group. Highest agreement was observed in the range of 20 ≤ HVPG \u0026lt; 24 mmHg. (R=0.52, ICC=0.66). The proportion of patients with a discrepancy between WHVP and PVP that was greater than 10% of the PVP value was highest in group A (95.3%) and lowest in group D (51.3%). Overestimation of PVP was more common in group E (48.5%), and underestimation of PVP was more common in group A (93.8%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e The correlation between WHVP and PVP varies significantly across HVPG levels, the highest agreement being in the range of 20 ≤ HVPG \u0026lt; 24 mmHg. WHVP frequently underestimates PVP when HVPG is \u0026lt; 12 mmHg and tends to overestimate PVP when HVPG is ≥ 24 mmHg.\u003c/p\u003e","manuscriptTitle":"Stratified Analysis of the Correlation between Wedged Hepatic Venous Pressure and Portal Venous Pressure in Patients with Portal Hypertension: A Multicenter Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-18 15:21:43","doi":"10.21203/rs.3.rs-4597526/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-09-27T05:24:54+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-26T13:42:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"322029192478215800669006794704104859219","date":"2024-09-13T13:32:52+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-27T15:56:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"224746233624127762914328534353652590949","date":"2024-08-18T20:04:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"214041222024961839365230494839894305186","date":"2024-08-13T00:38:26+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-08-07T04:24:03+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-08-07T04:22:23+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-06-21T13:28:55+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-19T07:17:03+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-06-18T05:41:52+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"eedf0522-7f4b-41ca-9c32-a9c4ccabe729","owner":[],"postedDate":"July 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":34149138,"name":"Health sciences/Gastroenterology/Hepatology"},{"id":34149139,"name":"Health sciences/Gastroenterology/Hepatology/Liver diseases/Portal hypertension"}],"tags":[],"updatedAt":"2024-12-02T15:59:16+00:00","versionOfRecord":{"articleIdentity":"rs-4597526","link":"https://doi.org/10.1038/s41598-024-80870-9","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2024-11-25 15:56:57","publishedOnDateReadable":"November 25th, 2024"},"versionCreatedAt":"2024-07-18 15:21:43","video":"","vorDoi":"10.1038/s41598-024-80870-9","vorDoiUrl":"https://doi.org/10.1038/s41598-024-80870-9","workflowStages":[]},"version":"v1","identity":"rs-4597526","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4597526","identity":"rs-4597526","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}