Abstract
Background: The prevalence of Hepatopulmonary Syndrome (HPS) ranges from 5 to 32% from liver-transplantation centers. Egypt is considered as one of the highest countries in prevalence and incidence of bilharizial
peri-portal fibrosis and Hepatitis C Virus (HCV) induced liver cirrhosis. Clinical, radiological and laboratory features
of HPS were not widely assessed.
Objectives: To determine the prevalence, clinical features and laboratory features of HPS among Egyptian
cirrhotic patients.
Patients and Methods: Our study included 570 cirrhotic patients. Arterial blood gases analysis, chest X-ray,
pulmonary function tests and transthoracic contrast echocardiography for detection of pulmonary vasodilatation were
done for patients with partial pressure of arterial O
2
<80 mmHg. Also, clinical and laboratory features were assessed.
Diagnostic criteria of HPS in cirrhotic patients include arterial hypoxemia and pulmonary vascular dilatation on
contrast enhanced echocardiography.
Results: The prevalence of HPS among patients with liver cirrhosis was 4.2%. Patients with HPS had more
severe cirrhosis, as determined by advanced Child-Pugh Grade. The presence of dyspnea, platypnea, clubbing,
and orthodoxia was significantly higher in patients with HPS when compared to cirrhotic patients (P value<0 .001).
In HPS, right pleural effusion and bilateral basal shadows were the commonest radiological findings (20.8% while
chest X- ray of most patients with liver cirrhosis was normal (85%) (P value<0.05). There was a significant decrease
in PaO
2and O
2saturation (P<0.001 for each) but a significant increase in P (A-a) O
2
in patients with HPS versus
cirrhotic patients (P<0.001). Patients with HPS showed a restrictive dysfunction in 59.3%.
Conclusion: The prevalence of HPS among cirrhotic patients was 4.2%. The presence of dyspnea, platypnea,
clubbing, orthodoxia and arterial hypoxemia were the commonest feature. Right pleural effusion and bilateral basal
shadows were the commonest radiological findings.