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

• Israel Grilo ^[2] ; Juan Manuel Pascasio ^[1] ; Francisco-Jesús López-Pardo ^[1] ; Francisco Ortega-Ruiz ^[1] ; Juan Luis Tirado ^[1] ; José Manuel Sousa ^[1] ; María José Rodríguez-Puras ^[1] ; María Teresa Ferrer ^[1] ; Miguel Ángel Gómez-Bravo ^[1] ; Antonio Grilo ^[3]
  1. [1] Hospital Universitario Virgen del Rocío

     Hospital Universitario Virgen del Rocío

     Sevilla, España

     
  2. [2] Hospital de Alta Resolución de Écija. Sevilla, Spain
  3. [3] Hospital Nuestra Señora de Valme. Sevilla, Spain

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• Localización: Revista Española de Enfermedades Digestivas, ISSN-e 2340-4167, ISSN 1130-0108, Vol. 109, Nº. 12, 2017, págs. 843-849
• Idioma: inglés
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  • Introduction: Different blood gas criteria have been used in the diagnosis of hepatopulmonary syndrome (HPS). Patients and methods: Arterial blood gases were prospectively evaluated in 194 cirrhotic candidates for liver transplantation (LT) in the supine and seated position. Three blood gas criteria were analyzed: classic (partial pressure of oxygen [PaO2] < 70 mmHg and/or alveolar-arterial gradient of oxygen [A-a PO2] ≥ 20 mmHg), modern (A-a PO2 ≥ 15 mmHg or ≥ 20 mmHg in patients over 64) and the A-a PO2 ≥ threshold value adjusted for age. Results: The prevalence of HPS in the supine and seated position was 27.8% and 23.2% (classic), 34% and 25.3% (modern) and 22.2% and 19% (adjusted for age), respectively. The proportion of severe and very severe cases increased in a seated position (11/49 [22.4%] vs 5/66 [7.6%], p = 0.02). No difference was observed in the pre-LT, post-LT and overall mortality in patients with HPS, regardless of the criteria used. Conclusion: Obtaining blood gas measurements in the supine position and the use of modern criteria are more sensitive for the diagnosis of HPS. Blood gas analysis with the patient seated detects a greater number of severe and very severe cases. The presence of HPS was not associated with an increase in mortality regardless of blood gas criterion used.