ORIGINAL ARTICLES   

Minerva Pneumologica 2006 December;45(4):215-9

Copyright © 2006 EDIZIONI MINERVA MEDICA

language: English

Respiratory abnormalities in patients with liver cirrhosis: not only hepatopulmonary sindrome

Amitrano L. ¹, De Michele F. ², Guardascione M. A. ¹, Menchise A. ¹, Manguso F. ¹, Ames P. R. ³, Santaniello W. ⁴, Calise F. ⁴, Balzano A. ¹

¹ Unit of Gastroenterology A. Cardarelli Hospital, Naples, Italy 2 Unit of Respiratory Pathophysiology A. Cardarelli Hospital, Naples, Italy 3 Department of Hematology, Inverclyde Royal Hospital, Greenock, Scotland 4 Unit of Hepato-biliary Surgery and Liver Transplantation A. Cardarelli Hospital, Naples, Italy

Aim. Patients with liver cirrhosis evaluated for liver transplantation may have not only arterial hypoxemia that characterizes he- pato-pulmonary syndrome but a number of gas exchange abnormalities whose prevalence and clinical significance is not well defined.
Methods. We studied 167 consecutive cirrhotic patients for pulmonary function tests, lung volumes and parameters of arterial gas exchange.
Results. A high prevalence of alterations of the lung diffusion (DLCOsb , DLCO/VA) were found. DA-aO2 >15 mmg Hg was present in 39.6% whilst overt hypoxemia only in 7.7% of the patients. PCO2 <35 mm Hg and pH>7.45 in 54.5% and 46.7% of the patients, respectively.
Conclusion. All these alterations indicate a latent hypoxemic state in these patients that may appear before the onset of arterial hypoxemia. Nevertheless, they did not correlate with Child Pugh‘s score or grade of esophageal varices. Altogether they have to be considered markers of the complex alteration of systemic haemodinamic present in patients with liver cirrhosis but their clinical significance is not presently completely known. The utility of screening such alterations in all liver transplant candidates is discussed.