Abstract
BackgroundHepatopulmonary syndrome (HPS) is a rare complication of liver diseases of different etiologies and may indicate a poor prognosis. Therefore, a simple non-invasive screening method to detect HPS would be highly desirable. In this study pulse oximetry was evaluated to identify patients with HPS.MethodsIn 316 consecutive patients with liver cirrhosis (n = 245), chronic hepatitis (n = 69) or non-cirrhotic portal hypertension (n = 2) arterial oxygen saturation (SaO2) was determined using a pulse oximeter. In patients with SaO2 ≤92% in supine position and/or a decrease of ≥4% after change from supine to upright position further diagnostic procedures were performed, including contrast-enhanced echocardiography and perfusion lung scan.ResultsSeventeen patients (5.4%) had a pathological SaO2. Four patients (1.3%) had HPS. HPS patients had a significant lower mean SaO2 in supine (89.7%, SD 5.4 vs. 96.0%, SD 2.3; p = 0.003) and upright position (84.3%, SD 5.0 vs. 96.0%, SD 2.4; p = 0.001) and had a lower mean PaO2 (56.2 mm Hg, SD 15.2 vs. 71.2 mm Hg, SD 20.2; p = 0.02) as compared to patients without HPS. The mean ΔSaO2 (difference between supine and upright position) was 5.50 (SD 7) in HPS patients compared to non-HPS patients who showed no change (p = 0.001). There was a strong correlation between shunt volume and the SaO2 values (R = -0.94).ConclusionArterial SaO2 determination in supine and upright position is a useful non-invasive screening test for HPS and correlates well with the intrapulmonary shunt volume.
Highlights
Hepatopulmonary syndrome (HPS) is a rare complication of liver diseases of different etiologies and may indicate a poor prognosis
The special qualities of HPS are platypnea [5], defined as dyspnoe induced by the upright position and relieved by recumbency and orthodeoxia [6], defined as arterial deoxygenation induced by the upright position and relieved by recumbency
contrastenhanced echocardiography (CEE) demonstrated in all four HPS patients the appearance of microbubbles in the left heart 4–6 heart cycles after the appearance in the right heart
Summary
Hepatopulmonary syndrome (HPS) is a rare complication of liver diseases of different etiologies and may indicate a poor prognosis. 36.3 42.5 21.2 was coined in 1977 by Kennedy and Knudson [2] These vascular abnormalities predominate in the lower lung fields. The special qualities of HPS are platypnea [5], defined as dyspnoe induced by the upright position and relieved by recumbency and orthodeoxia [6], defined as arterial deoxygenation induced by the upright position and relieved by recumbency. These phenomena are not pathognomonic for HPS, they strongly suggest this diagnosis in the setting of liver dysfunction [7]
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