Incidence of Hepatopulmonary syndrome in Cirrhosis of Liver
AbstractBackground: Patients of advanced liver cirrhosis regardless of the etiology may have coexistent hypoxemia, increased alveolar arterial oxygen gradient leading to hepatopulmonary syndrome which is documented by various techniques. Aim: To assess the incidence of HPS in 50 consecutive cirrhotic patients who presented to outpatients department or medical casualty. Patients: Patients of both gender, with ages between 12-70 years and belonged to any class of child`s Pugh classification were included. Results: Male and female patients included in the study were of equal number among patients with HPS and without HPS. Among the HPS patients HBsAg was 46.15 as compared to 32.43 in patients without HPS. Similarly more number of patients who had both HBsAg and anti HCV belonged to HPS positive group (15.38) in comparison to only 10.81, who were HPS negative. Number of episodes of encephalopathy were found to be more (1.85) among HPS patients, and less (0.90) among HPS negative patients. Portal vein diameter (in cm) was also found to be increased (13.61) among HPS patients and 11.94 among patients without HPS. Biochemical parameters also depicted greater derangement among the HPS patients like bilirubin was 4.05 among HPS in comparison to 1.92 in patients without HPS. Albumin was less 2.55g/dl in HPS patients while it was 3.50 among HPS negative patients. Prothrombin time (sec) was also more prolonged (6.92 sec) among HPS patients while it was 3.27 among HPS negative patients. Hypoxemia was more (62.73mmO2, partial pressure) among patients of HPs as compared to 79.24mmHg among patients without HPS. It was also noted that oxygen concentration was lowest in child`s class C (66.47) and 72.2% cases of HPs belonged to the same class. While 0% cases of HPs were present among child`s class a and b respectively. Conclusion: The incidence of HPS among our selected group of patients was found to be 26%. Hypoxemia worsened with the advancement of liver disease; oxygen concentration was 93.31±6.52, 83.58±7.58,66.47±8.09 among child`s class A, B and C respectively and the maximum HPS patients (72%) belonged to class C, in comparison to 0% among both child`s class A and B.
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