Hepatopulmonary syndrome: which blood gas analysis criteria and position should we use for diagnosis?

Grilo, Israel; Pascasio, J.M.; López-Pardo, Francisco; Ruiz, Francisco Órtega; Tirado, Juan Luis; Sousa, J.M.; Rodríguez-Puras, María J.; Ferrer, María Teresa Martínez; Gómez‐Bravo, Miguel Ángel; Grilo, Antonio

doi:10.17235/reed.2017.4930/2017

Cited by 10 publications

(7 citation statements)

References 23 publications

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“…Hepatopulmonary syndrome (HPS) is a progressive disease that is characterized by worsening hypoxemia due to intrapulmonary vascular dilatation (IPVD), arteriovenous malformations and increased angiogenesis in the setting of chronic liver disease 1–3 . The prevalence of HPS varies from 4% to 47% due to different cut-offs in defining arterial hypoxemia, and the mortality rate of HPS is ~41% 4–6 . Over the past two decades, the pathogenesis and precise mechanisms of HPS have been under active investigation.…”

Section: Introductionmentioning

confidence: 99%

Hepatocyte-derived exosomal MiR-194 activates PMVECs and promotes angiogenesis in hepatopulmonary syndrome

Chen

Han

et al. 2019

Cell Death Dis

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Hepatopulmonary syndrome (HPS) is a serious vascular complication in the setting of liver disease. Factors produced by the liver are essential to regulate pulmonary angiogenesis in the pathogenesis of HPS; however, the pathogenic mechanisms of pulmonary angiogenesis are not fully understood. We investigated the role of HPS rat serum exosomes (HEs) and sham-operated rat serum exosomes (SEs) in the regulation of angiogenesis. We found that HEs significantly enhance PMVEC proliferation, migration, and tube formation. We further identified miR-194 was the most notably increased miRNA in HEs compared to SEs. Once released, hepatocyte-derived exosomal miR-194 was internalized by PMVECs, leading to the promotion of PMVEC proliferation, migration, and tube formation through direct targeting of THBS1, STAT1, and LIF. Importantly, the pathogenic role of exosomal miR-194 in initiating angiogenesis was reversed by P53 inhibition, exosome secretion inhibition or miR-194 inhibition. Additionally, high levels of miR-194 were found in serum exosomes and were positively correlated with P(A-a)O2 in HPS patients and rats. Thus, our results highlight that the exosome/miR-194 axis plays a critical pathologic role in pulmonary angiogenesis, representing a new therapeutic target for HPS.

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Section: Introductionmentioning

confidence: 99%

Hepatocyte-derived exosomal MiR-194 activates PMVECs and promotes angiogenesis in hepatopulmonary syndrome

Chen

Han

et al. 2019

Cell Death Dis

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“…Eine erhöhte alveolar-arterielle Sauerstoffpartialdruckdifferenz (AaDO 2 ) ≥ 15 mmHg in einem Alter ≤ 64 Jahren bzw. ≥ 20 mmHg in einem Alter > 64 Jahre gilt als diagnostisch und wurde kürzlich in einer Kohorte von 194 Zirrhosepatienten validiert [416]. Die Blutabnahme sollte bei sitzendem Patienten in Ruhe unter Raumlauft erfolgen, die obligatorische Lungenfunktionstestung maximal geringe Veränderungen zeigen.…”

Section: Kommentarunclassified

Aktualisierte S2k-Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) „Komplikationen der Leberzirrhose“

et al. 2019

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ZusammenfassungDie Leitlinie Komplikationen der Leberzirrhose der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) ersetzt die Leitlinie aus dem Jahr 2011. Sie basiert auf den Empfehlungen der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) für eine evidenzbasierte Konsensus-Leitlinie der Entwicklungsstufe S2k und wurde interdisziplinär unter Beteiligung aller relevanten Fachgesellschaften und der Patientenvertretung erstellt. Neben den in der Vorgängerversion behandelten Kapiteln Aszites, spontan bakterielle Peritonitis, hepatorenales Syndrom, hepatischer Hydrothorax und hepatopulmonales Syndrom wurden die Kapitel Diagnostik und Therapie der Hepatischen Enzephalopathie neu aufgenommen.

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“…A recently accepted definition of arterial deoxygenation specifies an elevated alveolararterial oxygen gradient (>15 mmHg or >20 mmHg for age >65 years), rather than the use of partial oxygen pressure (PaO 2 ) alone [7]. Obtaining blood gas measurements with the patient in the supine rather than the upright position is suggested as a more sensitive method to detect HPS [8]. Interestingly, HPS can develop in acute or chronic liver disease, PH without liver disease, Wilson's disease and α1 antitrypsin deficiency [9].…”

Section: Hps Definition and Diagnostic Criteriamentioning

confidence: 99%

Pulmonary manifestations of chronic liver disease: a comprehensive review

Σουλαϊδόπουλος

Goulis

2020

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Hepatopulmonary syndrome (HPS) and porto-pulmonary hypertension (PoPH) represent relatively common pulmonary vascular complications of advanced liver disease. Despite distinct differences in their pathogenetic background, both clinical states are characterized by impaired arterial oxygenation and limited functional status, and are associated with increased pretransplantation mortality. Accumulation of ascitic fluid in the pleural cavity, known as hepatic hydrothorax (HH), is another frequent manifestation of decompensated cirrhosis, which may cause severe respiratory dysfunction, depending on the volume of the effusion, the rapidity of its development and its resistance to therapeutic measures. Orthotopic liver transplantation constitutes the only effective treatment able to resolve the pulmonary complications of liver disease. A prioritization policy for liver transplantation has evolved over the past years regarding advanced stages of HPS, yielding favorable outcomes regarding post-transplantation survival and HPS resolution. In contrast, severe PoPH is associated with poor post-transplantation survival. Hence, liver transplantation is recommended only for patients with PoPH and an acceptable reduction in pulmonary pressure values, after receiving PoPH-targeted vasodilating therapy. This review focuses on basic pathogenetic and diagnostic principles and discusses the current therapeutic approaches regarding HPS, PoPH, and HH.

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Hepatopulmonary syndrome: which blood gas analysis criteria and position should we use for diagnosis?

Cited by 10 publications

References 23 publications

Hepatocyte-derived exosomal MiR-194 activates PMVECs and promotes angiogenesis in hepatopulmonary syndrome

Hepatocyte-derived exosomal MiR-194 activates PMVECs and promotes angiogenesis in hepatopulmonary syndrome

Aktualisierte S2k-Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) „Komplikationen der Leberzirrhose“

Pulmonary manifestations of chronic liver disease: a comprehensive review

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