FREQUENCY AND PREDICTORS OF HEPATOPULMONARY SYNDROME IN CHRONIC LIVER DISEASE PATIENTS

Abstract

Introduction: Hepatopulmonary syndrome is not very uncommon among chronic liver disease patients in clinical practice.It is associated with shorter survival and poor liver function in cirrhotics. Although there are a large number of CLD patients in India, the exact frequency of HPS is not known & it needs evaluation.

Aims: To estimate the frequency of hepatopulmonary syndrome among Indian patients with chronic liver disease, study the correlation between HPS and the severity of liver disease and assess the factors predictive for diagnosis of HPS.

Methodology: A cross sectional study on total fifty patients (34 males, mean age 44.4 ± 7.3years) with chronic liver disease was conducted to diagnose the presence of hepatopulmonary syndrome. Patients were subjected to clinical examination, laboratory investigations, measurement of arterial blood gas and transthoracic contrast enhanced echocardiography. The severity of liver disease was assessed by Child-Pugh score.The diagnostic criteria for HPS were presence of intrapulmonary vascular dilatation(IPVD) documented by contrast enhanced echocardiography and alveolar arterial oxygen gradient of more than 15 mm Hg.

Results:.Nine of fifty patients (18%) with chronic liver diseas were found to have contrast echocardiographic evidence of intrapulmonary vasodilatation. Hepatopulmonary syndrome was observed in seven (14%) patients.We did not find any significant correlation between presence of HPS with severity of liver disease according to the Child-Pugh score. Features like dyspnoea, orthopnea, cyanosis, clubbing, platypnoea and orthodeoxia were significantly more common in the HPS group.

Conclusions: The frequency of HPS among the studied group of Indian patients with chronic liver disease was 14%. Though there was no significant correlation between presence of HPS with severity of liver disease according to the Child-Pugh score ; but presence of cyanosis, clubbing, dyspnoea and platypnoea–orthodeoxia are suggestive indicators of HPS.