Clinical risk factors for portopulmonary hypertension.
Portopulmonary hypertension affects up to 6% of patients with advanced liver disease, but the predictors and biologic mechanism for the development of this complication are unknown. We sought to determine the clinical risk factors for portopulmonary hypertension in patients with advanced liver disease. We performed a multicenter case-control study nested within a prospective cohort of patients with portal hypertension recruited from tertiary care centers. Cases had a mean pulmonary artery pressure > 25 mm Hg, pulmonary vascular resistance > 240 dynes x second x cm(-5), and pulmonary capillary wedge pressure < or = 15 mm Hg. Controls had a right ventricular systolic pressure < 40 mm Hg (if estimable) and normal right-sided cardiac morphology by transthoracic echocardiography. The study sample included 34 cases and 141 controls. Female sex was associated with a higher risk of portopulmonary hypertension than male sex (adjusted odds ratio = 2.90, 95% confidence interval 1.20-7.01, P = 0.018). Autoimmune hepatitis was associated with an increased risk (adjusted odds ratio = 4.02, 95% confidence interval 1.14-14.23, P = 0.031), and hepatitis C infection was associated with a decreased risk (adjusted odds ratio = 0.24, 95% confidence interval 0.09-0.65, P = 0.005) of portopulmonary hypertension. The severity of liver disease was not related to the risk of portopulmonary hypertension.


CONCLUSIONS
Female sex and autoimmune hepatitis were associated with an increased risk of portopulmonary hypertension, whereas hepatitis C infection was associated with a decreased risk in patients with advanced liver disease. Hormonal and immunologic factors may therefore be integral to the development of portopulmonary hypertension.
Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, 622 West 168th Street, PH 8E, Room 101, New York, NY 10032, USA. sk2097@columbia.edu
Steven M
SM
Kawut
Michael J
MJ
Krowka
James F
JF
Trotter
Kari E
KE
Roberts
Raymond L
RL
Benza
David B
DB
Badesch
Darren B
DB
Taichman
Evelyn M
EM
Horn
Steven
S
Zacks
Neil
N
Kaplowitz
Robert S
RS
Brown
Michael B
MB
Fallon
D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006526:Hepatitis C / Q000150:complications / Q000503:physiopathology; D019693:Hepatitis, Autoimmune / Q000150:complications; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology* / Q000517:prevention & control; D006976:Hypertension, Pulmonary / Q000209:etiology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors