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Hepatic Vein Pressure Gradient Reduction and Prevention of Variceal Bleeding in Cirrhosis: A Systematic Review Gennaro D’Amico, Juan Carlos Garcia-Pagan, Angelo Luca, Jaime Bosch Gastroenterology Volume 131, Issue 5, Pages (November 2006) DOI: /j.gastro Copyright © 2006 AGA Institute Terms and Conditions
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Figure 1 Structure of data extraction from the 12 included studies and of odds ratios calculation for the meta-analysis. Numbers are total number of patients available for analysis in the 12 studies. Gastroenterology , DOI: ( /j.gastro ) Copyright © 2006 AGA Institute Terms and Conditions
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Figure 2 Odds ratio (random effects model), log scale, for the risk of bleeding in patients with and, respectively, without HVPG reduction to ≤12 mm Hg regardless of whether they were included in studies for the prevention of first or recurrent bleeding. Each study is identified by the name of the first author and year of publication (references in the text). Squares indicate the odds ratio per each trial, and the size of the squares is proportional to the weight of trials. The horizontal bars denote the 95% confidence intervals of the odds ratios. The vertical solid line is the equivalence line, where the odds ratio is equal to 1. Odds ratios on the left of the equivalence line denote benefit, whereas those on the right denote harm with HVPG reduction. The vertical dashed line represents the pooled odds ratio of the whole set of studies. The diamond represents 95% CI of the pooled odds ratio. Gastroenterology , DOI: ( /j.gastro ) Copyright © 2006 AGA Institute Terms and Conditions
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Figure 3 Odds ratio (random effects model), log scale, for the risk of bleeding in patients with and, respectively, without HVPG reduction by ≥20% with a final HVPG >12 mm Hg, regardless of whether they were included in studies for the prevention of first or recurrent bleeding. Each study is identified by the name of the first author and year of publication (references in the text). Squares indicate the odds ratio per each trial, and the size of the squares is proportional to the weight of trials. The horizontal bars denote the 95% confidence intervals of the odds ratios. The vertical solid line is the equivalence line, where the odds ratio is equal to 1. Odds ratios on the left of the equivalence line denote benefit, whereas those on the right denote harm with HVPG reduction. The vertical dashed line represents the pooled odds ratio of the whole set of studies. Diamonds represent 95% CI of the pooled odds ratio, including and, respectively, excluding the McCormick et al study.33 Gastroenterology , DOI: ( /j.gastro ) Copyright © 2006 AGA Institute Terms and Conditions
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Figure 4 Odds ratio (random effects model), log scale, for the risk of bleeding in patients with and, respectively, without HVPG reduction by ≥20% or to ≤12 mm Hg, regardless of whether they were included in studies for the prevention of first or recurrent bleeding. Each study is identified by the name of the first author and year of publication (references in the text). Squares indicate the odds ratio per each trial, and the size of the squares is proportional to the weight of trials. The horizontal bars denote the 95% confidence intervals of the odds ratios. The vertical solid line is the equivalence line, where the odds ratio is equal to 1. Odds ratios on the left of the equivalence line denote benefit, whereas those on the right denote harm with the target HVPG reduction. The vertical dashed line represents the pooled odds ratio of the whole set of studies. Diamonds represent 95% CI of the pooled odds ratio, including and, respectively, excluding the McCormick et al study33 or both the McCormick et al33 and Villanueva et al 2004 studies.37 Gastroenterology , DOI: ( /j.gastro ) Copyright © 2006 AGA Institute Terms and Conditions
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Figure 5 Odds ratio (random effects model), log scale, for the risk of death in patients with and, respectively, without HVPG reduction by ≥20% or to ≤12 mm Hg, regardless of whether they were included in studies for the prevention of first or recurrent bleeding. Each study is identified by the name of the first author and year of publication (references in the text). Squares indicate the odds ratio per each trial, and the size of the squares is proportional to the weight of trials. The horizontal bars denote the 95% confidence intervals of the odds ratios. The vertical solid line is the equivalence line, where the odds ratio is equal to 1. Odds ratios on the left of the equivalence line denote benefit, whereas those on the right denote harm with the target HVPG reduction. The vertical dashed line represents the pooled odds ratio of the whole set of studies. Diamonds represent 95% CI of the pooled odds ratio, including and, respectively, excluding the Villanueva et al 2004 study.37 Gastroenterology , DOI: ( /j.gastro ) Copyright © 2006 AGA Institute Terms and Conditions
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Figure 6 Odds ratio for the risk of bleeding in patients with and, respectively, without HVPG reduction by ≥20% or to ≤12 mm Hg, according to 6 relevant variables, among which, 5 were significant at univariable analysis. Each study is represented by an open circle and may be identified by the corresponding value of each variable, reported in Tables 1–3. The area of each circle is proportional to the variance of each odds ratio estimate. The horizontal dashed line is the equivalence line, where the odds ratio is equal to 1. The study with the highest odds ratio (and the only one with an odds ratio >1, indicating a higher risk of bleeding with a reduction in HVPG) had the highest values for time to HVPG measurement and the highest proportion of patients with an HVPG <12. The plot of time from bleeding to the first HVPG monitoring includes only the studies for the prevention of recurrent bleeding. Gastroenterology , DOI: ( /j.gastro ) Copyright © 2006 AGA Institute Terms and Conditions
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Figure 7 Log-odds ratio for bleeding with and, respectively, without HVPG reduction by ≥20% or to ≤12 mm Hg, according to the only variable significant at multivariable meta-regression analysis, the time interval between the 2 HVPG measurements, together with the summary random effects meta-regression line. Each study is represented by an open circle and may be identified by the corresponding value of each variable, reported in Tables 1–3. The area of each circle is proportional to the variance of each log-odds ratio estimate. Gastroenterology , DOI: ( /j.gastro ) Copyright © 2006 AGA Institute Terms and Conditions
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