Hepatopulmonary syndrome is related to the development of acute-on-chronic liver failure and poor prognosis in cirrhotic patients

Abstract

Background & Aims:Long-term prospective data on hepatopulmonary syndrome (HPS) from a large number of patients, especially in Asian patients, are lacking. We evaluated the long-term prognosis of HPS and the development of acute-on-chronic liver failure (ACLF), and related factors. Methods:A total of 142 patients with cirrhosis who underwent saline-agitated contrast echocardiography for the diagnosis of HPS were enrolled and observed prospectively from 2014 to 2019. Results:A total of 59 patients (41%) were diagnosed with HPS (24 grade 1, 23 grade 2, 12 grade 3). Thirty-eight and 37 patients died in the HPS and non-HPS groups, respectively (p < 0.01). The 5-year survival rate was 47% in the HPS group and 62% in the non-HPS group. In the Cox proportional hazards model, HPS and Model for End-stage Liver Disease (MELD) score≥18, and Child-Turcotte-Pugh (CTP) class B/C were signi cant risk factors for mortality after adjusting for other risk factors (HPS hazard ratio [HR] = 1.9, p = 0.01; MELD score≥18 HR = 2.3, p < 0.01; CTP class B/C HR = 2.9, p < 0.01). Compared to that in non-HPS group, the HPS group had a signi cantly higher incidence of ACLF during follow-up (p < 0.01) and more frequently presented with lung involvement of ACLF (p = 0.03). Conclusions:In the long-term follow-up cohort, patients with HPS showed poorer prognosis than that of patients without HPS. HPS was a risk factor for ACLF development independent of hepatic dysfunction, and lung involvement was signi cantly common than without patients Lay SummaryIn this study, patients with cirrhosis diagnosed with hepatopulmonary syndrome had a poor prognosis and higher probability of Acute-on-Chronic failure than those who did not.

Hepatopulmonary syndrome: diagnosis and treatment

“…Гепатопульмональний синдром (ГПС) є серйозним легеневим ускладненням прогресуючої хвороби печінки, що призводить до поганого клінічного прогнозу, значно підвищує смертність і погіршує якість життя [1,2]. Він найчастіше виникає в пацієнтів із цирозом печінки (ЦП) і портальною гіпертензією (ПГ), але також може виникнути в пацієнтів з гострим або хронічним запальним захворюванням печінки, синдромом Budd-Chiari та низкою судинних аномалій, що характеризуються зміною кровотоку між печінкою та легенями, як-от кавопульмональні шунти й мальформація Abernethy [3].…”

Advances in Diagnostic Imaging of Hepatopulmonary Syndrome

“…The severity of HPS can be classified according to the PaO 2 into either mild (PaO 2 ≥80 mmHg), moderate (PaO 2 60-79 mmHg), severe (PaO 2 50-59 mmHg), or very severe (PaO 2 <50 mmHg) (4). HPS mostly occurs in patients with liver cirrhosis, with an incidence rate of 9.45-42.5% (5)(6)(7)(8)(9)(10). HPS is a serious pulmonary complication of end-stage liver disease.…”

“…HPS is a serious pulmonary complication of end-stage liver disease. The mortality of patients with HPS is significantly high and the prognosis is poor ( 10 ). Early detection and timely treatment may help improve the prognosis.…”