Hepatopulmonary Syndrome in Egyptian Patients with HCV- Related Chronic Liver Disease

Background and Aim: Hepatopulmonary syndrome (HPS) is defined as the presence of liver disease in association with intrapulmonary vascular dilatation and arterial hypoxemia. This work aimed at evaluation of hepatopulmonary syndrome in Egyptian patients with HCV-related chronic liver disease. Patients and Methods: This cross-sectional study included sixty patients with HCV-related chronic liver disease who underwent complete clinical evaluation, laboratory investigations, abdominal ultrasonography, plain chest x-ray, arterial blood gas analysis to assess partial pressure of arterial oxygen (PaO2), partial pressure of arterial carbon dioxide (PaCO2) and alveolar-arterial oxygen gradient (A-aDO2) in addition to pulmonary function tests. Results: The prevalence of HPS was 55% (33 out of the 60 patients). Thirteen cases of them were in Child B and 20 cases in Child C group. There was a highly significant difference between Child A & C and between Child B & C classes as regards PaO2.There was highly significant difference between the three Child classes as regards spirometry pattern, where 40% of Child C patients showed mild restrictive pattern. There was highly significant difference between positive HPS and negative HPS patients as regards PaO2, A-aDO2, VC (L), FVC (L), FEV-1(L/sec), and FEF25-75% (L/sec).There was highly significant positive correlation between A-aDO2 and each of age, INR and portal vein diameter. There was highly significant negative correlation between A-aDO2 and each of serum albumin, PaO2, VC, FVC, FEV-1 and FEF 25-75%. A cutoff level ≥ 18.4 mmHg for A-aDO2 could detect positive HPS with a sensitivity of 100%, specificity of 96.3%, PPV of 97.1% and NPV of 100%. Conclusion: A cutoff level ≥ 18.4 mmHg for A-aDO2 could detect HPS. There is significant correlation between the severity of chronic liver disease and the presence of HPS.