The complex interrelationships between chronic lung and liver disease: a review

Abstract

Lung complications may occur as a result of hepatic disease from any cause and represent a highly heterogeneous group of conditions. Early recognition of such complications may be challenging but is crucial both in forming a meaningful differential diagnosis and in avoiding severe sequelae and irreversible damage. Although a number of different pathogenetic mechanisms are likely to be involved, chronic liver dysfunction may cause pulmonary manifestations because of alterations in the production or clearance of circulating cytokines and other mediators. This is likely to be the case in hepatopulmonary syndrome, portopulmonary hypertension and primary biliary cirrhosis, although their pathogenesis remains largely speculative. Moreover, the severity of lung manifestations may or may not correspond to that of liver impairment, making disease outcome often unpredictable. Congenital and inflammatory disorders, however, may primarily affect both the liver and lung. Apart from specific diseases, a number of medications can also result in pulmonary and hepatic toxic effects. This is particularly important with cytokine therapy - used to treat viral hepatitis, among other diseases - because treatment consists of drug discontinuation, which, in turn, may cause reactivation or progression of the underlying disease that the drug was used for. This review summarizes salient diagnostic and therapeutic aspects of these often misdiagnosed conditions and highlights, based on the most recent literature, the need for early referral of such patients to centres with specific expertise in the field. In fact, a multidisciplinary approach involving pulmonologists, hepatologists and, in particularly severe cases, transplant surgeons has been already proven successful.

Determinants of elevated healthcare utilization in patients with COPD

“…Although there is no single pathogenetic mechanism involved, chronic liver dysfunction may cause pulmonary manifestations because of alterations in the production or clearance of circulating cytokines and other mediators [22]. Further, this association may be related to the effect of smoking that is an important risk factor for COPD and is commonly reported by patients with advanced liver disease.…”

The ET-1-mediated carbonylation and degradation of ANXA1 induce inflammatory phenotype and proliferation of pulmonary artery smooth muscle cells in HPS

“…Liver plays an important role in homoeostasis, and chronic liver diseases, such as cirrhosis and portal hypertension, often lead to the alterations of vasculature in multiple organs[1]. Hepatopulmonary syndrome(HPS), an advanced liver disease causing lung vascular disorder, has drawn more and more attention in recent years because of it high mortality.…”

“…In the arterial wall, PASMCs are normally quiescent and seldom to proliferate (<0.05%), and mainly in the G0/G1 phases of the cell cycle[5]. However, cytokines and growth factors during HPS cause PASMCs to re-enter cell cycle from the quiescence to proliferation state, which plays a key role in the formation and progression of PVR associated with HPS[1, 6]. …”

Development of a Murine Model of Early Sepsis in Diet-Induced Obesity

“…Lung and liver functions are very closely linked and hepatic dysfunction directly affects pulmonary function through cytokine production and clearance [30]. However, we found no changes in hepatic proinflammatory cytokine or chemokine levels to account for reduced lung injury.…”