Clinical features of hepatopulmonary syndrome in cirrhotic patients.
ABSTRACT To evaluate the frequency, clinical and paraclinical features of hepatopulmonary syndrome (HPS) and to determine their predictive values in diagnosis of this syndrome in patients in Iran.
Fifty four cirrhotic patients underwent contrast enhanced echocardiography to detect intrapulmonary and intracardiac shunts by two cardiologists. Arterial blood oxygen, O(2) gradient (A-a) and orthodoxy were measured by arterial blood gas (ABG) test. The patients positive for diagnostic criteria of HPS were defined as clinical HPS cases and those manifesting the intrapulmonary arterial dilation but no other criteria (arterial blood hypoxemia) were defined as lHPS cases. HPS frequency, sensitivity, positive and negative predictive values of clinical and paraclinical features were studied.
Ten (18.5%) and seven (13%) cases had clinical and subclinical HPS, respectively. The most common etiology was hepatitis B. Dyspnea (100%) and cyanosis (90%) were the most prevalent clinical features. Dyspnea and clubbing were the most sensitive and specific clinical features respectively. No significant relationship was found between HPS and splenomegaly, ascites, edema, jaundice, oliguria, and collateral veins. HPS was more prevalent in hepatitis B. PaO(2)< 70 and arterial-alveolar gradient had the highest sensitivity in HPS patients. Orthodoxy specificity was 100%.
Clubbing with positive predictive value (PPV) of 75% and dyspnea with negative predictive value (NPV) of 75% are the best clinical factors in diagnosis of HPS syndrome. PaO(2)< 70 and P (A-a) O(2)> 30 and their sum, are the most valuable negative and positive predictive values in HPS patients.
Full-textDOI: · Available from: Farhad Haj Sheikholeslami, Jul 26, 2015
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ABSTRACT: Patients with advanced liver disease are at a greater risk for cardiopulmonary complications (CPC) when compared with those with a healthy liver. In this study we tried to define a possible role of a triad of chest radiography (CXR), echocardiography and arterial blood gases (ABG) for the detection of CPC occurring as a result of liver cirrhosis of any cause. A total of 54 cirrhotic patients with no evidence of primary cardiac or chest disease were recruited during the period from August 2004 to September 2005. History taking and clinical examination as well as CXR postero-anterior view, transthoracic and contrast enhanced echocardiography (CEE) and ABG were done for all patients. Patients were classified according to Child-Pugh. Twenty patients suffered from CPC. Commonest symptoms were dyspnoea (55%), chest pain (37%) and cyanosis (7%). The CXR score of vascular-interstitial deficiency, echocardiographic diagnosis of pulmonary hypertension, right ventricular systolic pressure, cardiomyopathy and functional indices of pulmonary gas exchange were significantly increased in those patients with decompensated liver cirrhosis (Child C) compared to Child A and Child B patients. A triad of cardiopulmonary diagnostic tool is valuable in the clinical assessment of cardiopulmonary damage induced by liver cirrhosis. It helps to define classes of severity of liver disease and discriminate patients with advanced liver cirrhosis progressing to a hepatopulmonary syndrome, who are in need of prompt intensive management.
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ABSTRACT: Background and Aims: Hepatitis B virus (HBV) infection is a worldwide problem. It is estimated that 400 million people are suffering from this infection. We conducted a systematic review to put all evidence on HBV infection in I.R. Iran and to make an accurate estimate of HBV infection prevalence in Iran for further planning to control the infection.Study Design: Meta-analysis and survey data analysis of all national and international papers, theses, congresses, reports, Iranian medical universities projects, research centers, reports of Deputy for Health affairs (published or unpublished).Setting & Population: Iranian general population with positive HBsAg in blood samplesSelection Criteria for Studies: All descriptive/analytical cross-sectional studies/surveys from April 2001 to March 2007 that have sufficiently declared objectives, proper sampling method with identical and valid measurement instruments for all study subjects and proper analysis methods regarding sampling design and demographic adjustmentsOutcomes: Presence of positive HBsAg in blood samples of study samplesResults: Fourteen studies met the inclusion criteria. They were from 7 (out of 30) provinces in which about 40 percent of the country population live. These provinces (HBsAg positive prevalence) were Golestan (6.3%), Tehran (2.2%), East Azarbaijan (1.3%), Hamedan (2.3%), Isfahan (1.3%), Kermanshah (1.3%) and Hormozgan (2.4%). The HBV infection prevalence in Iran is estimated to be 2.14 percent (95%CI: 1.92-2.35), in men and women 2.55 percent (95%CI: 2.25- 2.85) and 2.03 percent (95%CI: 1.6-2.46 percent) respectively.Conclusions: About 1.5 million people in Iran are living with HBV infection (mild to moderate prevalence according to WHO classification) and it is assumed that 15% to 40% of them are at risk of developing cirrhosis and/or hepatocellular carcinoma (HCC) without intervention. The prevalence of HBV infection has been reported higher in more recent studies compared to the study in 2000-2001.Hepatitis Monthly 01/2008; 8(4). · 1.80 Impact Factor
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ABSTRACT: Background and objective TO describe the characteristics observed in patients diagnosed of hepatopulmonary syndrome (HPS) waiting for orthotopic liver transplantation and those who underwent liver trasplantation. Patients and method An observational prospective descriptive study was carried out of patients waiting for liver transplantation in whom data of liver illness and lung function tests were analy-zed. Results 107 patients of 53.69 years average age were studied (7.7 standard deviation). 24 of them (22.4%) had criteria of HPS. Ortodeoxia was present in the 34% of cases. The lung function tests were normal. In the comparative study between patients with HPS and no HPS, differences in diffusion were found (7.1 vs. 8.6 mmol/min/kPa; p = 0.04), as well as in the shunt (8% vs. 5.3%; p = 0.05) and the forced expiratory volume in one second (2,390 vs. 2,743 ml; p = 0.03). Seven patients were transplanted with correction of oxygenation and vascular dilatations in all of them. Conclusions HPS is a frequent illness in patients waiting for orthotopic liver transplantation. The main alteration in the blood oxygenation seems owe to shunt, and the diffusion tests is the analysis that could best differentiate patients with HPS. Orthotopic liver transplantation co-rrects the syndrome in all cases.Medicina Clínica 01/2008; 130(3):98-102. DOI:10.1157/13115351 · 1.25 Impact Factor