Associação entre gradiente de pressão portal e ascite em pacientes com cirrose

Abstract

Context - Portal hypertension plays an important role in the pathogenesis of ascites. Objectives - To evaluate the hepatic venous pressure gradient and the presence of ascites in cirrhotic patients. Methods - Eighty-three patients with cirrhosis were evaluated. All of the patients were submitted to ultrasonography to identify ascites and to a hepatic hemodynamic investigation to determine the hepatic venous pressure gradient. Results - In the population evaluated, ascites was observed in 70 patients (84.3%), and the mean hepatic venous pressure gradient was 15.26 ± 6.46 mm Hg. There was no statistically significant difference (P = 0.061) between the means of hepatic venous pressure gradient in patients with (14.70 ± 6.43 mm Hg) and without ascites (18.64 ± 5.78 mm Hg). When using a cut-off point of 8 mm Hg in order to assess the risk of developing ascites, patients with hepatic venous pressure gradient above 8 mm Hg were found to have a relative risk of 0.876 (CI = 0.74-1.03), (P = 0.446) of progressing to ascites. Conclusions - The pressure level of 8 mm Hg, as determined by the hepatic venous pressure gradient, does not define the presence or absence of ascites in the cirrhotic patient, and in view of the similarity between mean pressures in patients with or without peritoneal effusion, it is impossible to define a cut-off point for the emergence of such complication.