Clinical and diagnostic characteristics of hepatopulmonary syndrome among iranian patients with cirrhosis

ABSTRACT

Hepatopulmonary syndrome [HPS] is one of the pulmonary complications of cirrhosis, which is manifested by reduction in arterial blood oxygen. The present study was conducted to evaluate the frequency, clinical and para clinical features of HPS, and to determine their predictive values in diagnosis in a group of Iranian patients. This case series study was performed on 54 cirrhotic patients referred consecutively to the gastroenterology department of Taleghani Hospital between 2003 and 2004. Patients underwent pulmonary echo-contrast to detect intra-pulmonary and intra-cardiac shunts. Arterial blood oxygen, 0[2] gradient [A-a] and orthodoxy were measured in these patients by ABG. All patients underwent endoscopy for possible esophageal varices. Patients who met the following three diagnostic criteria including hepatic cirrhosis, arterial blood deoxygenation [P0[2]<80mmHg] and rapulmonary arterial dilation were classified as clinical HPS while those manifested solely with intrapulmonary arterial dilation were defined as subclinical HPS. Of 54 patients, 10 [18.5%] fulfilled clinical and 7 [13%] subclinical HPS criteria. Patients aged 71-80 years were more commonly affected. Hepatitis B was the most common etiologic factor. Dyspnea [100%] and cyanosis [90%] were the most prevalent clinical features. Dyspnea and clubbing were the most sensitive and specific clinical features, respectively. Pao[2]<70mmHg and arterial-alveolar gradient had the highest sensitivity for HPS diagnosis. Clubbing with the highest positive predictive value [75%] and dyspnea whit the highest negative predictive value [100%] were the best clinical features to diagnose HPS. PaO[2]<70mmHg and P[A-a]0[2]>30 and their sum, have the highest positive and negative predictive values in HPS diagnosis