title: Pulse oximetry is insufficient for timely diagnosis of hepatopulmonary syndrome in children with liver cirrhosis.
abstract: OBJECTIVE
  To prospectively investigate the prevalence of hepatopulmonary syndrome (HPS), the importance of pulse oximetry in diagnosing HPS, and the longitudinal course after liver transplantation in children with cirrhosis referred for liver transplantation.
  
  
  METHODS
  Fifty-six patients aged 1-17 years (mean age, 4.6 ± 5.0 years) with liver cirrhosis were screened for HPS by hyperemic capillary blood gas (CBG) analysis and contrast-enhanced transthoracic echocardiography. Eleven patients were excluded owing to conditions that can produce cardiopulmonary dysfunction, including 5 with cystic fibrosis, 1 with pulmonary arterial hypertension, and 5 with an intracardial shunt. HPS was classified in accordance with the European Respiratory Society Task Force criteria on pulmonary-hepatic disorders. Patient groups were compared for biochemical and clinical characteristics.
  
  
  RESULTS
  Eighteen children (40%) with cirrhosis were intrapulmonary vasodilatation (IPVD)-positive and had a pulse oximetry oxygen saturation level >98%. Two of these patients (11%) exhibited moderate HPS with an elevated alveolar arterial oxygen gradient >15 mm Hg and PaO2 <70 mm Hg; they died before undergoing liver transplantation. The sensitivity and specificity of CBG analysis for detecting elevated alveolar arterial oxygen gradient in children with IPVD was 94% and 53%, respectively. HPS was associated with late hepatoportoenterostomy (P < .04). Liver transplantation led to resolution of HPS in all patients.
  
  
  CONCLUSIONS
  IPVD is frequent in children with liver cirrhosis (40%). Pulse oximetry is insufficient for timely HPS diagnosis. Pathological CBG analysis data indicate IPVD in the majority of cases, but are imprecise in children aged <2 years. Contrast-enhanced transthoracic echocardiography and CBG analysis are recommended for evaluation of HPS in children with cirrhosis, regardless of liver synthesis capacity and clinical chemistry data.
authors: Clinic for Pediatrics II, Department of Pediatric Nephrology, Gastroenterology, Endocrinology, and Transplant Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany. Electronic address: a.hoerning@gmx.de.
authors: André
authors: A
authors: Hoerning
authors: Clinic for Pediatrics II, Department of Pediatric Nephrology, Gastroenterology, Endocrinology, and Transplant Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
authors: Simon
authors: S
authors: Raub
authors: Clinic for Pediatrics III, Department of Pediatric Cardiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
authors: Ulrich
authors: U
authors: Neudorf
authors: Clinic for Pediatrics III, Department of Pediatric Cardiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
authors: Carsten
authors: C
authors: Müntjes
authors: Clinic for Pediatrics II, Department of Pediatric Nephrology, Gastroenterology, Endocrinology, and Transplant Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
authors: Simone
authors: S
authors: Kathemann
authors: Clinic for Pediatrics II, Department of Pediatric Nephrology, Gastroenterology, Endocrinology, and Transplant Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
authors: Elke
authors: E
authors: Lainka
authors: Clinic for Pediatrics III, Department of Pediatric Pulmonology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
authors: Florian
authors: F
authors: Stehling
authors: Clinic for Pediatrics II, Department of Pediatric Nephrology, Gastroenterology, Endocrinology, and Transplant Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
authors: Peter F
authors: PF
authors: Hoyer
authors: Clinic for Pediatrics II, Department of Pediatric Nephrology, Gastroenterology, Endocrinology, and Transplant Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
authors: Patrick
authors: P
authors: Gerner
mesh_terms: D000293:Adolescent; D001784:Blood Gas Analysis; D002196:Capillaries / Q000737:chemistry; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D042241:Early Diagnosis; D004452:Echocardiography; D005260:Female; D020065:Hepatopulmonary Syndrome / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D008102:Liver Circulation; D008103:Liver Cirrhosis / Q000150:complications* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D010092:Oximetry; D010100:Oxygen / Q000097:blood; D011171:Portoenterostomy, Hepatic / Q000706:statistics & numerical data; D011446:Prospective Studies; D011650:Pulmonary Alveoli / Q000378:metabolism; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
chemical_list: D003287:Contrast Media; D010100:Oxygen