title: Hepatopulmonary syndrome: prevalence and predictors in Egyptian cirrhotic patients.
abstract: BACKGROUND
  The reported prevalence of hepatopulmonary syndrome (HPS) in cirrhotic patients is heterogeneous. Although the prevalence of chronic liver diseases is high in Egypt, however, scanty data is available about HPS.
  
  
  OBJECTIVE
  To assess the frequency of HPS and factors predictive of diagnosis of HPS in Egyptian patients with liver cirrhosis.
  
  
  METHODS
  Fifty cirrhotic patients were evaluated for the presence of HPS. Orthodeoxia was measured by arterial blood gas test. The patients positive for diagnostic criteria of HPS (the presence of A-a O2 > or = 15 mmHg and pulmonary vascular dilatation assessed by contrast enhanced echocardiography) were defined as clinical HPS cases and those manifesting with intrapulmonary arterial dilation but no other criteria were defined as subclinical HPS cases.
  
  
  RESULTS
  Subclinical HPS and clinical HPS was observed in 10 (20%) and 17 (34%) of the patients, respectively. The presence of HPS was significantly associated with severity of liver disease assessed by the Child-Pugh score (CP) or MELD score. Portal vein diameter (mm) (OR 3.3; 95% C.I 1.3-8.2; p=0.01) was the only independent predictor for HPS; the specificity of orthodeoxia for diagnosis of HPS was 100%.
  
  
  CONCLUSIONS
  HPS and intrapulmonary vein dilation are relatively frequent in patients with liver cirrhosis and occur in 34% and 20% of cirrhosis patients, respectively. They are associated with disease severity according to the MELD and CP score. Alveolar arterial oxygen gradient is the most valuable negative and positive diagnostic predictor for presence of HPS in cirrhotic patients.
authors.affiliation: Department of Internal Medicine, Medical School, Minia University, Egypt. mona.makarem@yahoo.com
authors.forename: Mona A Abu
authors.initials: MA
authors.lastname: El Makarem
authors.forename: Atef
authors.initials: A
authors.lastname: Elakad
authors.forename: Ahmed
authors.initials: A
authors.lastname: Ali
authors.forename: Mohammed
authors.initials: M
authors.lastname: Abd-Elkader
authors.forename: Azza Farag
authors.initials: AF
authors.lastname: Sayed
authors.forename: Amira
authors.initials: A
authors.lastname: Taha
authors.forename: Tarek
authors.initials: T
authors.lastname: Abd-Elrhman
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D004534:Egypt / Q000453:epidemiology; D005260:Female; D020065:Hepatopulmonary Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D012129:Respiratory Function Tests; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index