Prevalence and Associated Factors of Portopulmonary Hypertension in Patients with Portal Hypertension: A Case-Control Study

Abstract

Background and Aims. There are few studies on the prevalence and clinical characteristics of portopulmonary hypertension (POPH) in patients with portal hypertension. In addition, invasive right heart catheterization further limits the clinical diagnosis of POPH patients. Methods. From January 2018 to December 2019, 1004 patients with portal hypertension were treated in the Department of Hepatology, the First Hospital of Jilin University. Based on the inclusion and exclusion criteria, 188 patients with portal hypertension were finally included. We collected complete clinical data, laboratory examinations, and imaging examinations. Patients were divided into a POPH group and a non-POPH group based on echocardiographic results. We calculated the prevalence of POPH in patients with portal hypertension. The differences in clinical characteristics of the two groups of patients were compared. Results. The prevalence of POPH in patients with portal hypertension was 2.8%. Among the 188 patients with portal hypertension with fingertip oxygen saturation < 95 % at rest, 28 patients had POPH (12 males and 16 females), with an average age of 63 ± 8 , and 160 patients did not have POPH (110 males, 50 women), with an average age of 59 ± 11 . The proportion of women in the POPH group ( P < 0.01 ) and patients without liver cancer ( P = 0.044 ) was high. Compared to patients without POPH, patients with POPH had lower hemoglobin (related to the severity of anemia, P < 0.01 ), higher creatinine ( P < 0.05 ), and lower partial pressure of oxygen and carbon dioxide ( P < 0.05 ). Patients with POPH had a higher incidence of atrial enlargement, ventricular enlargement, mitral valve regurgitation, tricuspid regurgitation, pulmonary artery widening, pericardial effusion, and aortic regurgitation than those without POPH. The risk of POPH did not increase with the aggravation of the Child-Pugh classification. Conclusion. The prevalence of POPH in patients with portal hypertension is 2.8%. The proportion of women and nonliver cancer in POPH patients was higher than that in non-POPH patients. In addition, the POPH group had higher creatinine and lower hemoglobin, and echocardiography showed that POPH patients had more cardiac structural changes. In patients with portal hypertension, the risk in patients with POPH has nothing to do with the Child-Pugh classification and MELD score.

Prevalence and Clinical Features of Portopulmonary Hypertension in Patients With Hepatic Cirrhosis: An Echocardiographic Study

“…In line with this observation in literature, hemoglobin was statistically lower in patients with portopulmonary hypertension. The same observation was revealed in the study by Shao et al [ 10 ]. This observation was further fortified by Chen et al [ 11 ] who also identified hemoglobin as an independent risk factor.…”

“…Hepatitis B was the most common etiology. This observation is further fortified by other studies [ 10 , 11 ]. Hepatitis C was the most common cause reported by Chiva et al [ 9 ].…”

“…It is possible our study lacked statistical significance owing to the small sample size. However, this finding was found to be statistically significant in the study by Shao et al [ 10 ]. Moreover, Vergara et al [ 12 ] and Kawut et al [ 13 ] revealed female gender to be associated with a higher risk of portopulmonary hypertension than male gender.…”

“…Similarly, Chiva et al [ 9 ] reported a 1.7% prevalence in a Spanish population of cirrhotic patients. Shao et al [ 10 ] documented 2.8% prevalence in a Chinese population of cirrhotic patients. Vergara et al [ 3 ] observed a 6.1% prevalence in a Mexican population.…”

Application of Ultrasound Elastography in Assessing Portal Hypertension

“…Other than this, endoscopy helps to determine the existence of portal hypertension by the detection of indirect signs, like gastro-esophageal varices or the rupture of the gastro-esophageal varicose veins, which can also help classify the lesion for its risk of rupture [ 14 ]. In addition, pathological findings such as intrahepatic shunt formation, intrahepatic neo-angiogenesis, liver sinusoids capillarization, and abnormal fibrogenesis can also help to diagnose portal hypertension after a liver biopsy or hepatectomy [ 15 ]. However, for patients with a comparatively decompensated blood coagulation ability, the diagnostic risk is relatively high since these methods are invasive.…”