Paternostro R, Becker J, Hofer BS, et al. - Findings showed achievement of HVPG (hepatic venous pressure gradient)-response to non-selective beta-blocker (NSBB) therapy in 55.3% of NASH patients with varices and this appeared to protect from variceal bleeding. However, in patients with NASH cirrhosis and varices, decompensation/death was predicted only by baseline HVPG ≥ 20 mmHg, Child-Pugh stage B/C and MELD ≥ 15.

• This study involved 38 patients with NASH cirrhosis and varices receiving HVPG-guided NSBB therapy.

• HVPG-response to NSBB was achieved in 21(55.3%) cases.

• Factors independently linked with NSBB-response included: presence of diabetes(aOR:0.16) and arterial blood pressure (aOR:1.07).

• Fewer decompensations within 90 days were reported in NSBB-HVPG-responders [n = 1(5%) vs n = 3(29%)], and the composite endpoint (variceal bleeding, decompensation, and liver-related death) at 90 days was predicted by only Child-Pugh stage B/C, MELD ≥ 15 and HVPG ≥ 20 mmHg.

• Similarly, following 2 years of observation, the predictors of the composite endpoint were Child-Pugh stage (B:p = 0.001, C:p < 0.001), MELD ≥ 15 (p = 0.021), HVPG≥20 mmHg (p = 0.011).

• All bleeding events happened in HVPG-NSBB non-responders.