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Variability of Oxygenation in Possible Hepatopulmonary Syndrome: Effects of Requiring Two Abnormal Arterial Blood Gas Results for Diagnosis

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Abstract

Background and Aims

Hepatopulmonary syndrome (HPS) affects 10–32 % of patients with cirrhosis and is defined by liver abnormalities, intrapulmonary vascular dilatations (IPVDs), and abnormal oxygenation. However, published criteria for abnormal oxygenation are inconsistent. We sought to evaluate variation in oxygenation over time and to compare various diagnostic criteria for validity, based on their diagnostic stability over time and ability to identify patients with clinically relevant findings.

Methods

We retrospectively analyzed oxygenation and diffusion capacity in patients with liver abnormalities and IPVDs who had ≥2 arterial blood gases (ABGs) at the University of Toronto or Universite de Montreal. We compared the performance of nine possible oxygenation criteria for HPS and for each explored whether validity improved when requiring two consecutive abnormal ABGs on different days.

Results

Mean PaO2 was 68.4 mmHg and annual within-patient coefficient of variation 6.3 % (58 patients). Applying published criteria, 8.6–15.5 % of patients initially diagnosed with HPS no longer met the criterion for HPS on a subsequent ABG (re-classified). Requiring two consecutive abnormal ABGs on different days: (1) reduced the proportion of re-classified patients (9/9 criteria); (2) identified patients with more rapid progression in hypoxemia and greater difference in rate of progression between HPS and non-HPS (7/9 criteria); and (3) identified patients with lower diffusion and a larger difference in diffusion between HPS and non-HPS (8/9 criteria).

Conclusions

Oxygenation is variable in this population, and requiring two abnormal results might reduce misdiagnosis and better differentiate patients with and without HPS according to clinically relevant markers of disease.

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Abbreviations

AaDO2 :

Alveolar-arterial oxygen gradient

ABG:

Arterial blood gas

CE:

Contrast echocardiography

DLCO:

Diffusion capacity

HPS:

Hepatopulmonary syndrome

IPVDs:

Intrapulmonary vascular dilatations

PaO2 :

Partial pressure of arterial oxygen

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Acknowledgments

We would like to thank Dr. Marie E. Faughnan for her helpful comments on this manuscript. Mr. Dhruv Nayyar has been supported by the The Keenan Research Centre in the Li Ka Shing Knowledge Institute Summer Student Program. We would also like to acknowledge Dr. Pomier-Layrargues’ mentorship and leadership. He is missed dearly.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Medicine, University of Toronto, Suite 6042, Bond Wing, 30 Bond St., Toronto, ON, M5B 1W8, Canada

    Samir Gupta

  2. Division of Respirology, Department of Medicine, St. Michael’s Hospital, Suite 6042, Bond Wing, 30 Bond St., Toronto, ON, M5B 1W8, Canada

    Samir Gupta

  3. The Keenan Research Centre, Li Ka Shing Knowledge Institute, Suite 6042, Bond Wing, 30 Bond St., Toronto, ON, M5B 1W8, Canada

    Samir Gupta & Dhruv Nayyar

  4. Département de Medecine, Université de Montréal, Porte 320, 64 Boul. Rene-Levesque Est, Montreal, QC, H2X 1P1, Canada

    Gilles Pomier-Layrargues

  5. Centre de recherche, Hopital Saint-Luc du CHUM, Porte 320, 64 Boul. Rene-Levesque Est, Montreal, QC, H2X 1P1, Canada

    Gilles Pomier-Layrargues

Authors
  1. Samir Gupta
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  2. Dhruv Nayyar
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  3. Gilles Pomier-Layrargues
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Correspondence to Samir Gupta.

Additional information

Gilles Pomier-Layrargues: Deceased.

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Gupta, S., Nayyar, D. & Pomier-Layrargues, G. Variability of Oxygenation in Possible Hepatopulmonary Syndrome: Effects of Requiring Two Abnormal Arterial Blood Gas Results for Diagnosis. Dig Dis Sci 60, 1848–1855 (2015). https://doi.org/10.1007/s10620-014-3506-7

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  • DOI: https://doi.org/10.1007/s10620-014-3506-7

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