Clinical-liver, pancreas, and biliary tractPrognostic significance of the hepatopulmonary syndrome in patients with cirrhosis
Section snippets
Patients
A total of 111 adult patients with biopsy examination-proven cirrhosis consecutively admitted to our department irrespective of the presence of HPS between November 1996 and September 1998 for further management with special regard on the evaluation for orthotopic liver transplantation (OLT) were recruited for this study. Indication for OLT was made independently of the presence of HPS according to standard criteria.20 All patients underwent transthoracic contrast echocardiography, arterial
Study population
Twenty-seven patients (24%) fulfilled the criteria for diagnosis of HPS. Their clinical characteristics in comparison with those patients without HPS are shown in Table 1. Mean age, sex, and cause of cirrhosis was comparable in both groups. Patients with HPS had a higher mean Child-Pugh score (10.8 vs. 9.4, P < 0.05) and Model of End-Stage Liver Disease score (20.6 vs. 16, P < 0.01). In concordance, mean total bilirubin level was significantly higher, and mean values of serum albumin and
Discussion
This prospective clinical study showed that the presence of HPS has a major influence on survival in patients with cirrhosis. Patients with HPS showed a 3.8-times lower median survival time compared with those without this syndrome. But even subgroup analysis according to liver disease severity showed a clear survival disadvantage of HPS patients in Child-Pugh class C (5-times lower median survival). In cirrhotic patients with Child-Pugh class B, the difference in survival was less substantial
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