Evaluation of Predisposing Metabolic Risk Factors for Portopulmonary Hypertension in Patients with NASH Cirrhosis

Abstract

Purpose Metabolic parameters are important for the development of portopulmonary hypertension (PoPH) during nonalcoholic steatohepatitis (NASH)-associated cirrhosis. This study evaluated patients with NASH-associated cirrhosis to determine metabolic risk factors for portopulmonary hypertension. Patients and Methods Data on 171 patients (120 men and 51 women) with NASH-associated cirrhosis who were seen in Florence Nightingale Hospital’s gastroenterology Clinic from 2009 to 2018 was obtained from the Hospital database. A pulmonary artery systolic pressure >35 mmHg was defined as PH (pulmonary hypertension) according to standard transthoracic echocardiography. Portal hypertension was diagnosed from clinical symptoms and dilated portal veins shown by abdominal ultrasound or computed tomography (CT). Pulmonary patients with portal hypertension were diagnosed with portopulmonary hypertension (PoPH). Results A total of 171 patients with NASH-associated cirrhosis were included in this study. Of these, 43 patients had PoPH. These patients had increased TSH (p=0.004), bilirubin (p=0.023) and triglyceride (p=0.048) levels, higher MELD scores (p=0.018) and decreased hemoglobin (p=0.05). MELD score and hemoglobin, total bilirubin, TSH, and triglyceride levels were all included in a multivariate logistic regression model and TSH levels were independently associated with increased risk of PoPH. Conclusion Increased TSH is an independent risk factor for PoPH.

Determinants of Self-Care and Home-Based Management of Hypertension: An Integrative Review

“…This review identified and integrated the factors associated with home-based self-care management of hypertension. In chronic diseases like hypertension, home-based management is cardinal in improving a patient's outcome and the ability to avoid complications and limit the progress of the disease [41,42,43]. Hypertension patients must identify and institute home measures that help them improve their BP levels and avoid related complications.…”

“…Hypertension control through self-care at home was reported in similar systematic reviews to be influenced by diverse factors [41]. An important point of this home management involves measuring BP [42,43]. Self-care management of hypertension was instrumental when it was noted that intervention efficacy is most felt when the patient is used as the change agent [44].…”