Authors: Samir Gupta Dhruv Nayyar Gilles PomierLayrargues
Publish Date: 2015/01/14
Volume: 60, Issue: 6, Pages: 1848-1855
Abstract
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 findingsWe 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 daysMean PaO2 was 684 mmHg and annual withinpatient coefficient of variation 63 58 patients Applying published criteria 86–155 of patients initially diagnosed with HPS no longer met the criterion for HPS on a subsequent ABG reclassified Requiring two consecutive abnormal ABGs on different days 1 reduced the proportion of reclassified patients 9/9 criteria 2 identified patients with more rapid progression in hypoxemia and greater difference in rate of progression between HPS and nonHPS 7/9 criteria and 3 identified patients with lower diffusion and a larger difference in diffusion between HPS and nonHPS 8/9 criteria
Keywords: