Hepatopulmonary syndrome: which blood gas analysis criteria and position should we use for diagnosis?

Revista Espanola de Enfermedades Digestivas

Antonio Grilo¹  Miguel Ángel Gómez-Bravo²  Juan Luis Tirado²  María José Rodríguez-Puras²  José Manuel Sousa²  Juan Manuel Pascasio²  Francisco Ortega-Ruiz²  María Teresa Ferrer²  Francisco Jesús López-Pardo²  Israel Grilo³ 

[1]Hospital Nuestra Señora de Valme

[2]Hospital Universitario Virgen del Rocío

[3]Hospital de Alta Resolución de Écija

关键词: Cirrhosis;    Ascites;    Contrast echocardiography;    Pulmonary vascular diseases;    Macro-aggregated albumin lung perfusion scan and perioperative care;   

DOI  :  10.17235/reed.2017.4930/2017

来源: DOAJ

【 摘 要 】

Introduction: Different blood gas criteria have been used in the diagnosis of hepatopulmonary syndrome (HPS). Patients and methods: Arterial blood gases were prospectively evaluated in 194 cirrhotic candidates for liver transplantation (LT) in the supine and seated position. Three blood gas criteria were analyzed: classic (partial pressure of oxygen [PaO2] < 70 mmHg and/or alveolar-arterial gradient of oxygen [A-a PO2] ≥ 20 mmHg), modern (A-a PO2 ≥ 15 mmHg or ≥ 20 mmHg in patients over 64) and the A-a PO2 ≥ threshold value adjusted for age. Results: The prevalence of HPS in the supine and seated position was 27.8% and 23.2% (classic), 34% and 25.3% (modern) and 22.2% and 19% (adjusted for age), respectively. The proportion of severe and very severe cases increased in a seated position (11/49 [22.4%] vs 5/66 [7.6%], p = 0.02). No difference was observed in the pre-LT, post-LT and overall mortality in patients with HPS, regardless of the criteria used. Conclusion: Obtaining blood gas measurements in the supine position and the use of modern criteria are more sensitive for the diagnosis of HPS. Blood gas analysis with the patient seated detects a greater number of severe and very severe cases. The presence of HPS was not associated with an increase in mortality regardless of blood gas criterion used.

【 授权许可】

Unknown