Year 2017 / Volume 109 / Number 12
Original
Hepatopulmonary syndrome: which blood gas analysis criteria and position should we use for diagnosis?

843-849

DOI: 10.17235/reed.2017.4930/2017

Israel Grilo, Juan Manuel Pascasio, Francisco-Jesús López-Pardo, Francisco Ortega-Ruiz, Juan Luis Tirado, José Manuel Sousa, María José Rodríguez-Puras, María Teresa Ferrer, Miguel Ángel Gómez-Bravo, Antonio Grilo,

Abstract
Introduction: Different blood gas criteria have been used in the diagnosis of hepatopulmonary syndrome (HPS). Patients and methods: Arterial blood gases were prospectively evaluated in 194 cirrhotic candidates for liver transplantation (LT) in the supine and seated position. Three blood gas criteria were analyzed: classic (partial pressure of oxygen [PaO2] < 70 mmHg and/or alveolar-arterial gradient of oxygen [A-a PO2] ≥ 20 mmHg), modern (A-a PO2 ≥ 15 mmHg or ≥ 20 mmHg in patients over 64) and the A-a PO2 ≥ threshold value adjusted for age. Results: The prevalence of HPS in the supine and seated position was 27.8% and 23.2% (classic), 34% and 25.3% (modern) and 22.2% and 19% (adjusted for age), respectively. The proportion of severe and very severe cases increased in a seated position (11/49 [22.4%] vs 5/66 [7.6%], p = 0.02). No difference was observed in the pre-LT, post-LT and overall mortality in patients with HPS, regardless of the criteria used. Conclusion: Obtaining blood gas measurements in the supine position and the use of modern criteria are more sensitive for the diagnosis of HPS. Blood gas analysis with the patient seated detects a greater number of severe and very severe cases. The presence of HPS was not associated with an increase in mortality regardless of blood gas criterion used.
Share Button
New comment
Comments
No comments for this article
References
1.- Rodriguez-Roisin R, Krowka MJ, Herve P, Fallon MB; ERS Task Force Pulmonary-Hepatic Vascular Disorders (PHD) Scientific Committee. Pulmonary-Hepatic vascular Disorders (PHD). Eur Respir J 2004; 24: 861-880.
2.- Rodríguez Roisin R, Krowka MJ. Hepatopulmonary syndrome. A liver-induced lung vascular disorder. N Engl J Med 2008; 358: 2378-87.
3.- Abrams GA, Sanders MK, Fallon MB. Utility of pulse oximetry in the detection of arterial hypoxemia in liver transplant candidates. Liver Transpl 2002;8:391-396.
4.- Arguedas MR, Singh H, Faulk DK, Fallon MB. Utility of pulse oximetry screening for hepatopulmonary syndrome. Clin Gastroenterol Hepatol 2007 Jun;5:749-754.
5.- Roberts DN, Arguedas MR, Fallon MB .Cost-effectiveness of screening for hepatopulmonary syndrome in liver transplant candidates. Liver Transpl 2007 ;13:206-214.
6.- Stoller JK, Lange PA, Westveer MK, Carey WD, Vogt D, Henderson M. Prevalence and reversibility of the hepatopulmonary syndrome after liver transplantation. The Cleveland Clinic Experience. West J Med 1995; 163:133-138.
7.- Abrams GA, Nanda NC, Dubovsky EV, Krowka MJ, Fallon MB. Use of macroaggregated albuming lung perfusion scan to diagnose hepatopulmonary syndrome: a new approach. Gastroenterology 1998; 114: 305-310.
8.- Aller R, Moya JL, Moreira V, Boixeda D, et al. Diagnosis of hepatopulmonary syndrome with contrast transesophageal echocariography. Advantages over contrast transthoracic echocardiography. Dig Dis Sci 1999; 44: 1243-1248.
9.- Schenk P, Schoniger-Hekele M, Fuhrmann V, Madl C, Silberhumer G et al. Prognostic significance of the hepatopulmonary syndrome in patients with cirrhosis. Gastroenterology 2003; 125: 1042-1052.
10.-Lima BL, França AV, Pazin-Filho A, Araújo WM, et al. Frequency, clinical characteristics, and respiratory parameters of hepatopulmonary syndrome. Mayo Clin Proc 2004; 79: 42-48.
11.- Schiffer E, Majno P, Mentha G, Giostra E, et al. Hepatopulmonary syndrome increases the postoperative mortality rate following liver transplantation: a prospective study in 90 patients. Am J Transplant 2006; 6: 1430-1437.
12.- Fallon MB, Krowka MJ, Brown RS, Trotter JF et al. Impact of hepatopulmonary syndrome on quality of life and survival in liver transplant candidates. Gastroenterology 2008; 135: 1168-1175.
13.- Schenk P, Fuhrmann V, Madl C, Funk G, et al. Hepatopulmonary syndrome: prevalence and predictive value of various cut offs for arterial oxygenation and their clinical consequences. Gut 2002; 51: 853-859.
14.- Goldberg DS, Krok F, Batra S, Trotter JF, et al. Impact of the hepatopulmonary syndrome MELD exception policy on outcomes of patients after liver transplantation: an analysis of the UNOS database. Gastroenterology 2014; 146: 1256-1265.
15.- Sulieman BM, Hunsicker LG, Katz DA, Voight MD. OPTN policy regarding prioritization of patients with hepatopulmonary syndrome: Does it provide equitable organ allocation? Am J Transplant 2008; 8: 954–964.
16.- Swanson KL, Wiesner RH, Krowka MJ. Natural history of hepatopulmonary syndrome: Impact of liver transplantation. Hepatology 2005; 41: 1122–1129.
17.- Pascasio JM, Grilo I, López-Pardo FJ, Ortega-Ruiz F, Tirado JL, Sousa JM et al. Prevalence and severity of hepatopulmonary syndrome and its influence on survival in cirrhotic patients evaluated for liver transplantation. Am J Transplant 2014 ;14 :1391-1399.
18.- Abrams GA, Jaffe CC, Hoffer PB, Binder HJ, Fallon MB. Diagnostic utility of contrast echocardiography and lung perfusion scan in patients with hepatopulmonary syndrome. Gastroenterology 1995; 109: 1283-1288.
19.- Krowka MJ, Dickson ER, Cortese DA. Hepatopulmonary syndrome. Clinical observations and lack of therapeutic response to somatostatin analogue. Chest 1993; 104: 515-521.
20.- Gómez FP, Martínez-Pallí G, Barberá JA, Roca J, et al. Gas exchange mechanism of ortodesoxia in hepatopulmonary syndrome. Hepatology 2004; 40 : 660-666.
21.- Deberaldini M, Arcanjo ABB, Melo E, da Silva RF et al. Hepatopulmonary syndrome: morbidity and survival after liver transplantation. Transplant Proc 2008; 40: 3512-3516.
22.- Arguedas MR, Abrams GA, Krowka MJ, Fallon MB. Prospective evaluation of outcomes and predictors of mortality in patients with hepatopulmonary syndrome undergoing liver transplantation. Hepatology 2003; 37: 192–197.
23.- Gupta S, Castel H, Rao RV, et al. Improved survival after liver transplantation in patients with hepatopulmonary syndrome. Am J Transplant 2010; 2: 354-363.
24.- Kim HY, Choi MS, Lee SC, et al. Outcomes in patients with hepatopulmonary syndrome undergoing liver transplantation. Transplant Proc 2004; 36: 2762–2763.
Related articles

Editorial

Treatment of portal vein thrombosis in cirrhosis patients

DOI: 10.17235/reed.2023.9800/2023

Editorial

AKI-HRS, more than a name change for type-1 hepatorenal syndrome

DOI: 10.17235/reed.2023.9677/2023

Letter

Tolvaptan in portal hypertension: real life experience

DOI: 10.17235/reed.2022.9145/2022

Editorial

New actors come into play against hepatitis delta

DOI: 10.17235/reed.2022.9050/2022

Letter

Hemoperitoneum due to rupture of intra-abdominal varices

DOI: 10.17235/reed.2022.8937/2022

Letter

Cirrhotic pattern in advanced hepatic sarcoidosis

DOI: 10.17235/reed.2021.8446/2021

Digestive Diseases Image

Giant cystic hepatocarcinoma in the absence of cirrhosis

DOI: 10.17235/reed.2021.8313/2021

Review

Physical frailty in liver transplantation

DOI: 10.17235/reed.2020.7448/2020

Case Report

Using octreotide for refractory ascites after liver transplantation

DOI: 10.17235/reed.2019.6316/2019

Review

Risk stratification and treatment of primary biliary cholangitis

DOI: 10.17235/reed.2018.5662/2018

Case Report

Long-evolution ascites in a patient with constrictive pericarditis

DOI: 10.17235/reed.2015.3728/2015

Citation tools
Grilo I, Pascasio J, López-Pardo F, Ortega-Ruiz F, Tirado J, Sousa J, et all. Hepatopulmonary syndrome: which blood gas analysis criteria and position should we use for diagnosis?. 4930/2017


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 1053 visits.
This article has been downloaded 296 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 05/03/2017

Accepted: 28/08/2017

Online First: 03/10/2017

Published: 04/12/2017

Article revision time: 175 days

Article Online First time: 212 days

Article editing time: 274 days


Share
This article hasn't been rated yet.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology