Impact of propofol sedation on the diagnostic accuracy of hepatic venous pressure gradient measurements in patients with cirrhosis.
Cirrhosis
Diagnostic accuracy
HVPG
Portal hypertension
Sedation
Journal
Hepatology international
ISSN: 1936-0541
Titre abrégé: Hepatol Int
Pays: United States
ID NLM: 101304009
Informations de publication
Date de publication:
Aug 2022
Aug 2022
Historique:
received:
31
07
2021
accepted:
05
10
2021
pubmed:
27
10
2021
medline:
6
8
2022
entrez:
26
10
2021
Statut:
ppublish
Résumé
Measurement of the hepatic venous pressure gradient (HVPG) is the gold standard to evaluate the presence and severity of portal hypertension. The procedure is generally safe and well tolerated, but nevertheless, some patients demand for sedation. However, it is unknown whether propofol sedation would impair the accuracy of portal pressure measurements. This is a prospective observational cohort study including cirrhotic patients with suspected portal hypertension undergoing invasive measurement of HVPG. Measurements of HVPG were performed in awake condition as well as under sedation with propofol infusion. In total, 37 patients were included. Mean HVPG in awake condition was 15.9 mmHg (IQR 13-19) and during sedation 14.1 mmHg (IQR 12-17). While measures of free hepatic vein pressure (FHVP) were not altered after propofol sedation (p = 0.34), wedged hepatic vein pressure values (WHVP) decreased in an average by 2.05 mmHg (95% CI - 2.46 to - 1.16; p < 0.001) which was proportional to the magnitude of HVPG. In 31 out of 37 patients (83.8%), portal hypertension with HVPG ≥ 12 mmHg was found. Under sedation with propofol, two patients (5.4%) with borderline values would have been incorrectly classified as < 12 mmHg. After adjustment for the average difference of - 10%, all patients were correctly classified. Intraclass correlation coefficient between HVPG measurement in awake condition and under propofol sedation was 0.927 (95% CI 0.594-0.975). Propofol sedation during HVPG measurements is generally safe, however it may lead to relevant alterations of HVPG readings.
Sections du résumé
BACKGROUND
BACKGROUND
Measurement of the hepatic venous pressure gradient (HVPG) is the gold standard to evaluate the presence and severity of portal hypertension. The procedure is generally safe and well tolerated, but nevertheless, some patients demand for sedation. However, it is unknown whether propofol sedation would impair the accuracy of portal pressure measurements.
METHODS
METHODS
This is a prospective observational cohort study including cirrhotic patients with suspected portal hypertension undergoing invasive measurement of HVPG. Measurements of HVPG were performed in awake condition as well as under sedation with propofol infusion.
RESULTS
RESULTS
In total, 37 patients were included. Mean HVPG in awake condition was 15.9 mmHg (IQR 13-19) and during sedation 14.1 mmHg (IQR 12-17). While measures of free hepatic vein pressure (FHVP) were not altered after propofol sedation (p = 0.34), wedged hepatic vein pressure values (WHVP) decreased in an average by 2.05 mmHg (95% CI - 2.46 to - 1.16; p < 0.001) which was proportional to the magnitude of HVPG. In 31 out of 37 patients (83.8%), portal hypertension with HVPG ≥ 12 mmHg was found. Under sedation with propofol, two patients (5.4%) with borderline values would have been incorrectly classified as < 12 mmHg. After adjustment for the average difference of - 10%, all patients were correctly classified. Intraclass correlation coefficient between HVPG measurement in awake condition and under propofol sedation was 0.927 (95% CI 0.594-0.975).
CONCLUSIONS
CONCLUSIONS
Propofol sedation during HVPG measurements is generally safe, however it may lead to relevant alterations of HVPG readings.
Identifiants
pubmed: 34699037
doi: 10.1007/s12072-021-10261-z
pii: 10.1007/s12072-021-10261-z
pmc: PMC9349095
doi:
Substances chimiques
Propofol
YI7VU623SF
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
817-823Informations de copyright
© 2021. The Author(s).
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