Clinical features of hepatopulmonary syndrome in cirrhotic patients.
OBJECTIVE
To evaluate the frequency, clinical and paraclinical features of hepatopulmonary syndrome (HPS) and to determine their predictive values in diagnosis of this syndrome in patients in Iran.


METHODS
Fifty four cirrhotic patients underwent contrast enhanced echocardiography to detect intrapulmonary and intracardiac shunts by two cardiologists. Arterial blood oxygen, O(2) gradient (A-a) and orthodoxy were measured by arterial blood gas (ABG) test. The patients positive for diagnostic criteria of HPS were defined as clinical HPS cases and those manifesting the intrapulmonary arterial dilation but no other criteria (arterial blood hypoxemia) were defined as lHPS cases. HPS frequency, sensitivity, positive and negative predictive values of clinical and paraclinical features were studied.


RESULTS
Ten (18.5%) and seven (13%) cases had clinical and subclinical HPS, respectively. The most common etiology was hepatitis B. Dyspnea (100%) and cyanosis (90%) were the most prevalent clinical features. Dyspnea and clubbing were the most sensitive and specific clinical features respectively. No significant relationship was found between HPS and splenomegaly, ascites, edema, jaundice, oliguria, and collateral veins. HPS was more prevalent in hepatitis B. PaO(2)< 70 and arterial-alveolar gradient had the highest sensitivity in HPS patients. Orthodoxy specificity was 100%.


CONCLUSIONS
Clubbing with positive predictive value (PPV) of 75% and dyspnea with negative predictive value (NPV) of 75% are the best clinical factors in diagnosis of HPS syndrome. PaO(2)< 70 and P (A-a) O(2)> 30 and their sum, are the most valuable negative and positive predictive values in HPS patients.
Mohammad Alizadeh
Amir Houshang
AH
Research Center for Gastroenterology and Liver Disease, Shaheed Beheshti University of Medical Sciences, 7th floor, Taleghani Hospital, Yaman Str., Evin, 19857 Tehran, Iran. article@rcgld.org
Fatemi
Seyed Reza
SR
Mirzaee
Vahid
V
Khoshbaten
Manoochehr
M
Talebipour
Bahman
B
Sharifian
Afsaneh
A
Khoram
Ziba
Z
Haj-sheikh-oleslami
Farhad
F
Gholamreza-shirazi
Masoomeh
M
Zali
Mohammad Reza
MR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003490:Cyanosis / Q000150:complications / Q000473:pathology; D004417:Dyspnea / Q000150:complications / Q000473:pathology; D004452:Echocardiography; D006509:Hepatitis B / Q000150:complications / Q000473:pathology; D020065:Hepatopulmonary Syndrome / Q000150:complications* / Q000175:diagnosis / Q000473:pathology*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis / Q000473:pathology*; D008875:Middle Aged; D010005:Osteoarthropathy, Secondary Hypertrophic / Q000150:complications / Q000473:pathology; D011237:Predictive Value of Tests