Year 2017 / Volume 109 / Number 12
Original
Hepatopulmonary syndrome: which blood gas analysis criteria and position should we use for diagnosis?

843-849

DOI: 10.17235/reed.2017.4930/2017

Israel Grilo, Juan Manuel Pascasio, Francisco-Jesús López-Pardo, Francisco Ortega-Ruiz, Juan Luis Tirado, José Manuel Sousa, María José Rodríguez-Puras, María Teresa Ferrer, Miguel Ángel Gómez-Bravo, Antonio Grilo,

Abstract
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.
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Grilo I, Pascasio J, López-Pardo F, Ortega-Ruiz F, Tirado J, Sousa J, et all. Hepatopulmonary syndrome: which blood gas analysis criteria and position should we use for diagnosis?. 4930/2017


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Publication history

Received: 05/03/2017

Accepted: 28/08/2017

Online First: 03/10/2017

Published: 04/12/2017

Article revision time: 175 days

Article Online First time: 212 days

Article editing time: 274 days


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