Hepatopulmonary syndrome is associated with the presence of hepatocellular carcinoma in patients with decompensated cirrhosis

Abstract

BackgroundHepatopulmonary syndrome (HPS) is a relatively common complication in patients with decompensated cirrhosis. Our aim was to evaluate the prevalence of HPS, its clinical impact, and the possible association between HPS and characteristics of patients with decompensated cirrhosis.MethodsPatients with stable decompensated cirrhosis admitted to our department and assessed for HPS were included. For each patient, several clinical, laboratory and echocardiographic parameters as well as renal function were recorded. The severity of liver disease was evaluated according to the Model for End-stage Liver Disease and Child-Pugh scores, and renal function was assessed using 51chromium complexed with ethylene diamine tetracetic acid. In addition, the short synacthen test was performed in each patient to evaluate the adrenal function.ResultsSixty-three patients were enrolled, 26 (41.3%) of whom diagnosed with HPS. In multivariate analysis, the presence of hepatocellular carcinoma [odds ratio (OR) 8.1, 95% confidence interval (CI) 5.3-27.9, P=0.045] and salivary cortisol at T60 (60 min after the intravenous injection of 250 μg corticotropin) (OR 0.88, 95%CI 0.71-0.98, P=0.045) were the factors independently associated with HPS. T60 salivary cortisol had relatively good discriminative ability for the presence of HPS (area under the curve=0.73). The presence of HPS was not associated with the outcome (P=0.22).ConclusionIn our cohort of patients with decompensated cirrhosis, the presence of hepatocellular carcinoma and T60 salivary cortisol were the only factors independently associated with HPS.

Successful venoarterial extracorporeal membrane oxygenation for prolonged hepatopulmonary syndrome following pediatric liver transplantation: A case report and review of the literature

“…HPS is defined by the triad of liver disease, widened A‐a gradient leading to impaired oxygenation and intrapulmonary vasodilatation . Impaired oxygenation is due to vascular structural alterations and vasodilatation of the precapillary and post‐capillary vasculature resulting in right‐to‐left intrapulmonary shunting . This leads to increased A‐a gradient due to a ventilation‐perfusion mismatch causing hypoxemia .…”

Pulmonary manifestations of chronic liver disease: a comprehensive review

“…The accumulation of CD68+ macrophages in the lungs, in combination with circulating inflammatory chemokines, such as tumor necrosis factor (TNF)-α, trigger the activation of VEGF angiogenic signaling pathways, as has been shown in experimental animal models [31]. These pathways may also be responsible for the recently demonstrated associations between HPS and hepatocellular carcinoma, also characterized by excessive VEGF production and angiogenesis [32]. Thus, it is not surprising that anti-VEGF treatment with sorafenib improves HPS hypoxia and intrapulmonary shunting in cirrhotic rats [33].…”

The indices of endogenous intoxication in rats with different models of hepatopulmonary syndrome

“…The most frequent clinical symptoms of HPS are progressive dyspnea and platypnea 5 , but neither is specific for HPS. Digital clubbing, with a positive predictive value of 75%, was the best clinical sign associated with the presence of HPS, while a correlation between the presence of spider angiomas and HPS was also demonstrated recently, suggesting that they could be used as skin markers of HPS [6][7] .…”