title: Clinical features of hepatopulmonary syndrome in cirrhotic patients.
abstract: 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.
authors.affiliation: 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
authors.forename: Amir Houshang
authors.initials: AH
authors.lastname: Mohammad Alizadeh
authors.forename: Seyed Reza
authors.initials: SR
authors.lastname: Fatemi
authors.forename: Vahid
authors.initials: V
authors.lastname: Mirzaee
authors.forename: Manoochehr
authors.initials: M
authors.lastname: Khoshbaten
authors.forename: Bahman
authors.initials: B
authors.lastname: Talebipour
authors.forename: Afsaneh
authors.initials: A
authors.lastname: Sharifian
authors.forename: Ziba
authors.initials: Z
authors.lastname: Khoram
authors.forename: Farhad
authors.initials: F
authors.lastname: Haj-sheikh-oleslami
authors.forename: Masoomeh
authors.initials: M
authors.lastname: Gholamreza-shirazi
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Zali
mesh_terms: 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