Frequency of hepatopulmonary syndrome and portopulmonary hypertension in cirrhotic liver patients

Abbas S El-Maraghy, Ahmed A Abu Naglah, Ayman Amin, Kamal A Merghany, Mohamed M Khalil

Egyptian Journal of Bronchology 2018 12(1):119-128

Background Chronic liver diseases may cause abnormal changes in the pulmonary vascular bed. There are two important and pathophysiologically different pulmonary vascular abnormalities − hepatopulmonary syndrome (HPS) and portopulmonary hypertension (PPHTN). Pathophysiologically, HPS results from vasodilatation, whereas PPHTN results from vasoconstriction. Objective The objective of this study was to determine the frequency of HPS and PPHTN in dyspneic cirrhotic hepatic patients. Patients and methods This study included 87 patients with cirrhotic liver disease admitted to Al-Azhar University Hospitals from September 2013 to September 2015. The diagnosis of cirrhosis was based on clinical, biochemical, serological, and metabolic workup, abdominal ultrasound, or liver biopsy. All patients in this study were subjected to complete medical history taking and clinical examination, liver function tests, plain chest radiography, and thoracic high-resolution computed tomography, abdominal ultrasonography, arterial blood gas analysis in the supine and standing positions, calculation of alveolar–arterial oxygen gradient, saline two-dimensional contrast-enhanced echocardiography, and right-heart catheterization only for all cases with PPHTN. Results The present study showed that the prevalence of HPS was 25.28% (22 out of 87 cases) and was higher than the prevalence of PPHTN, which was 5.7% (5 out of 87 cases). Conclusion HPS and PPHTN are not uncommon in patients with hypoxemia and chronic hepatic disease. Diagnoses of such disorders are essential, especially in patients who are listed for liver transplantation.

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