Volume 137, Issue 1, Pages 119-128 (July 2009) Acute Hemodynamic Response to β-Blockers and Prediction of Long-term Outcome in Primary Prophylaxis of Variceal Bleeding  Càndid Villanueva, Carles Aracil, Alan Colomo, Virginia Hernández–Gea, Josep M. López–Balaguer, Cristina Alvarez–Urturi, Xavier Torras, Joaquim Balanzó, Carlos Guarner  Gastroenterology  Volume 137, Issue 1, Pages 119-128 (July 2009) DOI: 10.1053/j.gastro.2009.03.048 Copyright © 2009 AGA Institute Terms and Conditions

Figure 1 Receiver operating characteristic curves for first bleeding of acute and chronic response to β-blockers. Continuous line represents HVPG changes after the acute administration of IV propranolol (c statistic, 0.83; 95% CI, 0.75–0.9). The optimal cutoff point was an >10% reduction in HVPG, with 81% sensitivity and 80% specificity (the traditional criteria of a reduction of ≥20% had 94% sensitivity but only 40% specificity). The discontinuous line represents HVPG changes after the chronic administration of nadolol (c statistic, 0.83; 95% CI, 0.72–0.91; P = .77 compared with c statistic after acute administration of propranolol). The optimal cutoff point was an ≥9% reduction in HVPG, with 92% sensitivity and 77% specificity (the traditional criteria of a reduction of ≥20% had 100% sensitivity but only 42% specificity). Gastroenterology 2009 137, 119-128DOI: (10.1053/j.gastro.2009.03.048) Copyright © 2009 AGA Institute Terms and Conditions

Figure 2 Probability of (A) first bleeding and (B) survival, according to acute hemodynamic response (defined as a decrease in HVPG decrease >10% from baseline or to <12 mmHg). (A) The probability of remaining free of first variceal bleeding was significantly higher in hemodynamic responders (continuous line) than in nonresponders (dashed line; P < .001). (B) The probability of survival was slightly better in hemodynamic responders (continuous line) than in nonresponders, although the difference was not significant (P = .08). Gastroenterology 2009 137, 119-128DOI: (10.1053/j.gastro.2009.03.048) Copyright © 2009 AGA Institute Terms and Conditions

Figure 3 CART analysis of risk factors for first variceal bleeding. Classification and regression tree analysis identified acute hemodynamic response as the most efficient first splitting variable of risk of bleeding. The NIEC index provides additional prognostic value in acute nonresponders. First variceal bleeding occurred in 75% of nonresponders with NIEC index >30. Gastroenterology 2009 137, 119-128DOI: (10.1053/j.gastro.2009.03.048) Copyright © 2009 AGA Institute Terms and Conditions

Figure 4 Probability of (A) first bleeding and (B) survival, according to chronic hemodynamic response (defined as a decrease in HVPG decrease >10% from baseline or to <12 mmHg). (A) The probability of remaining free of first variceal bleeding was significantly higher in hemodynamic responders (continuous line) than in nonresponders (dashed line; P < .001). (B) The probability of survival was significantly higher in hemodynamic responders (continuous line) than in nonresponders (dashed line; P = .01). Gastroenterology 2009 137, 119-128DOI: (10.1053/j.gastro.2009.03.048) Copyright © 2009 AGA Institute Terms and Conditions