Detection of hepatopulmonary syndrome in patient with liver cirrhosis
Abstract
Background: Hepatopulmonary syndrome (HPS) is a pulmonary vascular disorder, complicating hepatic disease, and is responsible for an increased morbidity and mortality among patients awaiting liver transplantation. Nowadays, it is recognized as an independent risk factor for death in this patient population. The severity of hypoxemia and the advanced stage of the liver dysfunction are determinants for the prognosis. Therefore, the possibility to be successful, thus improving survival, consists of addressing HPS at an earlier stage, giving more attention to moderate evidences of this pathology instead of the severe ones.
Patients and methods: Between the year 2000 and first half of the year 2005 we observed 115 patients with liver cirrhosis B and C expressed as class of Child-Pough classification of different etiology and portal hypertension (63 men and 52 women). All patients were included on the basis of inclusion and eyclusion criterion.
Results: Clinically we suspected on hepatopulmonary syndrome in 18 patients. With 100 % oxygen inhalation test we confirmed the hepatopulmonary syndrome in 9 patients (57.7 %), 6 men and 3 women, on the other hand contrast echosonography was positive in 8 patients (51.3 %), 5 men and 3 women. All these patients had liver cirrhosis grade C, expressed as class of Child-Pough.
Conclusions: On the basis of scientific evidence, we suggest a sample for detecting HPS among patients with liver cirrhosis, founded on the integration of two main factors: the severity of hepatic disease, expressed as class of Child-Pough, and the severity of the hypoxemia. The key role in diagnosis of hepatopulmonary syndrome are anamnesis of platipnea and arterial blood oxygen analysis as a less invasive diagnostic methods. However final diagnosis is achieved with 100 % oxygen inhalation test and contrast echosonography.
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References
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