title: Clinical characteristics, predictors, and survival among patients with hepatopulmonary syndrome.
abstract: BACKGROUND
  Hepatopulmonary syndrome (HPS) is a complication of advanced liver disease. The impact of HPS on survival is not clearly understood.
  
  
  METHODS
  A prospective study was carried out at Department of Medicine, King Edward Medical University Lahore from June 2011 to May 2012. Patients with cirrhosis of liver were evaluated for presence of HPS with arterial blood gas analysis and saline bubble echocardiography. All patients were followed for 6 months for complications and mortality. Cox regression analysis was done to evaluate role of HPS on patient survival.
  
  
  RESULTS
  110 patients were included in the study. Twenty-nine patients (26%) had HPS. MELD score was significantly higher (p < 0.01) in patients with HPS (18.93 ± 3.51) as compared to that in patients without HPS (13.52 ± 3.3). Twenty two (75.9%) patients of Child class C, 5 (17.2%) patients of Child class B and 2 (6.9%) patients of Child class A had HPS (P 0.03). The clinical variables associated with presence of HPS were spider nevi, digital clubbing, dyspnea, and platypnea. HPS significantly increased mortality during six month follow up period (HR: 2.47, 95% CI: 1.10- 5.55). Child-Pugh and MELD scores were also associated with increased mortality. HPS was no longer associated with mortality when adjustment was done for age, gender, Child-Pugh, and MELD scores (HR: 0.44, 95% CI: 0.14-1.41). Both the Child-Pugh and MELD scores remained significantly associated with mortality in the multivariate survival analysis.
  
  
  CONCLUSIONS
  HPS indicates advanced liver disease. HPS does not affect mortality when adjusted for severity of cirrhosis.
authors: Nawaz Sharif Medical College Gujrat, Pakistan.
authors: Irfan
authors: I
authors: Younis
authors: King Edward Medical University Lahore, Pakistan.
authors: Shahid
authors: S
authors: Sarwar
authors: Prince George's Hospital Center, Cheverly MD, USA.
authors: Zeeshan
authors: Z
authors: Butt
authors: Services Hospital Lahore, Pakistan.
authors: Sheharyar
authors: S
authors: Tanveer
authors: Military Hospital Rawalpindi, Pakistan.
authors: Adnan
authors: A
authors: Qaadir
authors: Center for Biomedical Research, Lahore, Pakistan; Nishtar Medical College Hospital, Multan-Pakistan.
authors: Nauman Arif
authors: NA
authors: Jadoon
mesh_terms: D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D020065:Hepatopulmonary Syndrome / Q000175:diagnosis / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends