The Relationship Between Severity of Liver Cirrhosis and Pulmonary Function Tests

Abstract

Pulmonary complications, mainly hepatopulmonary syndrome (HPS), are frequently observed in liver cirrhosis. In this study, the aim was to investigate the frequency of hypoxemia and impairment of pulmonary function tests (PFT) in patients with liver cirrhosis and to examine the relationships of these impairments with liver failure. A total of 39 patients with cirrhosis, 24 males and 15 females, were included in our study. The mean age of the patients was 47.5 +/- 17.2 years. Arterial blood gases, PFT, and carbon monoxide diffusion tests (DLCO) were performed in all patients. Out of 39 cirrhotic patients, 21 (53.8%) had ascites, whereas 18 (46.2%) did not. Seven patients were in the Child-Pugh A group, 21 in the Child-Pugh B group, and 11 patients were in the Child-Pugh C group. Hypoxia was found in 33.3% of the patients. Although the PaO2 and SaO2 values of patients with ascites were lower compared to those without ascites (P < 0.05), no statistically significant difference was determined in the comparison of hypoxia between the groups (P > 0.05). Among the PFT parameters, FEV1/FVC and FEF25-75% values were found to be lower in patients with ascites than those without (P < 0.05). No differences were established between these two groups of patients in terms of DLCO (P > 0.05). While no differences were found in comparison of the DLCO values in between the groups (P > 0.05), there was a statistically significant difference in the ratio of DLCO to the alveolar ventilation (DLCO/VA) in between the groups (P < 0.05). On the other hand, a negative correlation was found between the DLCO/VA and Child points when the relationship between the Child-Pugh score and PFT parameters were investigated (r = -0.371, P < 0.05). Consequently, a relationship was established between the severity of liver failure and diffusion tests showing pulmonary complications invasively. We believe diffusions tests should be performed in addition to the PFT in order to determine pulmonary involvements particularly in patients who are candidates for liver transplantation.

Reduced baroreflex sensitivity and pulmonary dysfunction in alcoholic cirrhosis: effect of hyperoxia

“…In cirrhotic patients, a low BRS indirectly expresses a reduced vagal tone and significantly contributes to the impaired cardiovascular regulation (2,3,10). In addition, cirrhotic patients have a pulmonary dysfunction with arterial hypoxemia and reduced lung diffusing capacity, since this is seen in more than 80% of the patients (31,33,49). The present article was based on the hypothesis that the reduced BRS could at least partly be attributed to arterial hypoxemia owing to the pulmonary dysfunction and that normalization of the low Pa O 2 values would improve the BRS.…”

Report of seven children with hepatopulmonary syndrome

“…The CHILD classification, which reflects the degree of liver failure, is used in determining the prognosis in cirrhotic patients (31). No correlation has been reported between the severity of hepatic dysfunction and that of HPS (23).…”

“…Among our patients who had MAA scans, none had severe HPS based on the degree of intrapulmonary shunting. However, we do not know the shunt fraction value of Case 6, who died of respiratory problems after LT.The CHILD classification, which reflects the degree of liver failure, is used in determining the prognosis in cirrhotic patients (31). No correlation has been reported between the severity of hepatic dysfunction and that of HPS (23).…”

Abnormal hyperventilation in patients with hepatic cirrhosis: Role of enhanced chemosensitivity to carbon dioxide

“…A reduction in respiratory gas exchange efficiency is a rather common finding in patients with hepatic cirrhosis, resulting in a wide spectrum of arterial oxygenation abnormalities [1,2]. On the one hand, an association between vascular abnormalities and parenchymal pulmonary diseases is believed to be responsible for oxygen delivery failure [3]: in particular, a mismatch between pulmonary ventilation and perfusion has been described as a consequence of abnormalities involving vascular bed (intrapulmonary vasodilatation), hemodynamics (hyperdynamic circulation) and ventilation (early airway closure, alveolar restriction, organic parenchimal causes) [4].…”