671 HEPATORENAL SYNDROME IN PATIENTS WITH HEPATOPULMONARY SYNDROME

Abstract

Background and Aims: Hepatopulmonary syndrome (HPS) occurs in 20–30% of patients with cirrhosis. Patients with HPS have >2fold increased mortality. Contributing causes are unknown. There is lack data of concerning impairment of kidney function and hepatorenal syndrome (HRS) in patients with HPS. Methods: 203 patients with liver cirrhosis were screened for presence of HPS and HRS. HPS wsa defined according to consensus guidelines (1.) cirrhosis, 2.) AaDO2 >15mmHg, 3.) intrapulmonary vascular dilatation in contrast enhanced echocardiography). [1] HRS was defined according to established criteria. [2] Liver transplantation and survial was assessed during follow up. A p-value 1.5mg/dL. Underlying causes of renal impairment were HRS in 12 (33%), diabetic nephropathy in 6 (17%), hypovloemia in 8 (22%), glomerulanephritis in 3 (8%) and shock in 7 (19%) patients. HRS was the only cause of renal impairment that was significantly higher in HPS positive patients (7 (54%) versus 5 (22%), p < 0.05). Multivariate regression analysis revealed 2 risk factors for presence of HRS: refractory ascites (OR 33.4, p < 0.001) and presence of HPS (OR 4.9, p < 0.05). Discussion: HPS is an independent riask factor for presence of HRS. Patients with HRS should be screened for presence of HPS for early recognition and oxygen administration in case of severe gas exchange abnormality.