Original ArticleFrequency, Clinical Characteristics, and Respiratory Parameters of Hepatopulmonary Syndrome
Section snippets
PATIENTS AND METHODS
The diagnosis of hepatic cirrhosis (HC) was based on clinical and laboratory criteria and on histologic analysis when available. Hepatopulmonary syndrome was defined by the presence of HC and IPVDs detected by transthoracic contrast-enhanced echocardiography (CEE) and of disorders of arterial oxygenation represented by a Pao2 of less than 70 mm Hg or an AaPo2 of more than 20 mm Hg.1 The study was approved by the Ethics Committee of the University Hospital of the Faculty of Medicine of Ribeirão
RESULTS
Sixty consecutive cirrhotic patients who were candidates for OLT were evaluated prospectively from August 2001 to August 2002. Fifty-six patients (93%) concluded the protocol. The exclusion of 4 patients was due to an inadequate acoustic window for transthoracic CEE in 2 patients, to the death of 1 patient before the conclusion of the protocol, and to the impossibility of performing pulmonary function evaluation in 1 patient.
Twenty-five (45%) of the 56 patients had IPVDs as detected by
DISCUSSION
Until recently, it was difficult to define HPS because no consensus existed among investigators about the diagnostic criteria for the syndrome. Although doubts still persist today, some aspects have been better defined. In the current study, which used the criteria recommended by Krowka and Cortese,15 16% of the cirrhotic patients assessed for OLT were found to have HPS, a frequency similar to that reported in the literature, which ranges from 4% to 32%3, 16, 17, 18 according to the criteria
CONCLUSIONS
The frequency of HPS is high among cirrhotic patients who are candidates for OLT. Although IPVDs are frequent among candidates for OLT, most patients do not fulfill the criteria for HPS. The Dlco value does not seem to be a good marker for HPS screening because it is reduced in patients both with and without HPS. We emphasize the role of AaPo2 as a more reliable index than Pao2 (even with higher cutoff levels) and of Dlco in the determination of changes in arterial oxygenation in cirrhotic
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