Clinical

Hepatopulmonary syndrome common in patients with hypoxic hepatitis

Last Updated: 2006-07-28 17:10:26 -0400 (Reuters Health)

By Martha Kerr

NEW YORK (Reuters Health) - Nearly half of patients with hypoxic or ischemic hepatitis suffer from hepatopulmonary syndrome (HPS), with a mortality rate of nearly 50%, Austrian researchers report in the July issue of Gastroenterology.

Hypoxic hepatitis is the leading cause of liver impairment among in-patients, but it hasn't been proven if HPS accompanies hypoxic hepatitis, note Dr. Valentin Fuhrmann and his colleagues at the Medical University Vienna. The team identified 44 patients with hypoxic hepatitis and 62 critically ill patients with cardiopulmonary diseases but without hypoxic hepatitis.

Patient with hypoxic hepatitis were screened for HPS by blood tests, including blood gases, and on contrast-enhanced echocardiography.

Eighteen of the 44 patients with hypoxic hepatitis had elevated serum aspartate transaminase levels and blood gases and echocardiography indicative of HPS. Tests for increased intrapulmonary vasodilation were negative in the other 62 critically ill patients.

"Hepatopulmonary syndrome is reversible after normalization of the hepatic dysfunction in patients with hypoxic hepatitis," Dr. Fuhrmann told Reuters Health. "However, we did not observe complete resolution of hepatopulmonary syndrome with mechanical ventilation."

Dr. Fuhrmann noted that "all critically ill patients with hypoxic hepatitis had severe gas exchange abnormalities due to their underlying disease that caused hepatopulmonary syndrome. However, hepatopulmonary syndrome was not the only cause of respiratory insufficiency in our patients."

"Currently, orthotopic liver transplantation is the only therapy established to reverse intrapulmonary vasodilatation in patients with liver cirrhosis. No randomized controlled trials of pharmacologic therapies are published, but supplemental oxygen improves oxygenation," Dr. Fuhrmann said. "Oxygen should be given to every patient with severe dyspnea associated with hepatopulmonary syndrome."

Gastroenterology 2006;131:69-76.