[Gasometric alterations in hospitalized cirrhotic patients].
OBJECTIVE
Gas exchange alterations have been described in cirrhotic patients; but by the moment, a few prospective studies have focused in them. The aim of this study was to describe the frequency and severity of gasometric alterations in hospitalized cirrhotic patients, a their correlation with hepatocellular disfunction.


METHODS
50 consecutive cirrhotic patients (41 males) admitted for liver decompensation (ascites, liver encephalopathy, alcoholic hepatitis and upper gastrointestinal bleeding) without acute or chronic cardiopulmonary disfunction were included in the study. Patients were classified according with Child-Pugh score (A, n = 13; B, n = 21; C, n = 16). Severe alcoholic hepatitis (SAH) was confirmed in 7 patients. Arterial gasometry was performed in all patients before discharge. Contrast echocardiography was performed in any case of suspicion of hepatopulmonary syndrome (HPS).


RESULTS
Light hypoxemia was observed (80.9 mmHg), without differences with Child-Pugh. Hypocapnia was significantly more evident in Child C than in A and B (31.2 +/- 3.1 vs. 38.1 +/- 4.3 y 36.3 +/- 5 mmHg; p < 0,05), respectively. Cirrhotic patients with SAH showed a significantly higher hypocapnia by comparison with others (31.2 +/- 3.1 vs. a 36.3+/-5 mmHg; p < 0.05). In multivariate analysis, independent prognostic variables for hypocapnica were plasmatic levels of protrombin time, albumin and sodium. HPS was confirmed in 8 patients (16%).


CONCLUSIONS
The most prevalent gas exchange abnormality in cirrhosis was the alteration of alveolar-arterial oxygen tension gradient, directly correlated with hepatocellur disfunction. Hypocapnia could be a compensatory mechanism or the result of the activation of central respiratory centres by non-depurated substances by the liver.
Servicio de Aparato Digestivo, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona. vlorenzo@ns.hugtip.scs.es
V
V
Lorenzo-Zúñiga
M A
MA
Alvarez
R
R
Planas
R
R
Morillas
E
E
Domènech
E
E
Cabré
M A
MA
Gassull
D000222:Adaptation, Physiological; D000368:Aged; D001784:Blood Gas Analysis; D002245:Carbon Dioxide / Q000097:blood; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D020065:Hepatopulmonary Syndrome / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D016857:Hypocapnia / Q000209:etiology; D000860:Hypoxia / Q000209:etiology; D007297:Inpatients; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D017093:Liver Failure / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D011379:Prognosis; D011446:Prospective Studies; D011517:Prothrombin Time; D011659:Pulmonary Gas Exchange; D012720:Severity of Illness Index; D012964:Sodium / Q000097:blood; D013577:Syndrome
D002245:Carbon Dioxide; D012964:Sodium; D010100:Oxygen