An analysis on the clinical characteristics and associated factors of decompensated cirrhosis complicated by hepatopulmonary syndrome

Abstract

Abstract: Objective This study aims to investigate the general clinical characteristics and associated factors of hepatopulmonary syndrome (HPS) in patients with decompensated cirrhosis. Methods A total of 83 patients with decompensated cirrhosis who met the inclusion criteria and were admitted to the Second Affiliated Hospital of Xi′an Jiaotong University from October 2023 to August 2024 were enrolled in this study. The participants were grouped based on the presence or absence of HPS. Comprehensive clinical data and laboratory test results were collected and compared between HPS and Non-HPS groups of patients. Results Among the 83 patients, 59% were male; additionally, 61.45% (51/83) exhibited intrapulmonary vascular dilatations (IPVD), while 39.8% (33/83) had HPS. Notably, HPS was observed in 54.1% of those patients positive for IPVD. No significant differences in disease duration, age, etiology, or gender were found between the HPS group and non-HPS group (P>0.05). Symptoms such as shortness of breath, and cyanosis occurred in 51.5% and 24.2% of HPS patients, respectively, which were significantly higher than those of 26% and 6% reported in the non-HPS group (P=0.021 and 0.006, respectively). The incidence rate of prior gastrointestinal bleeding was recorded at 51.5% within the HPS cohort compared to only 26% among non-HPS individuals (P=0.018). Furthermore, median PaO₂ levels in the HPS group (76 mmHg) were significantly lower than those observed in their non-HPS counterparts (87 mmHg) (P=0.022). Additionally, serum albumin levels within the HPS cohort were markedly reduced compared to those without HPS (P=0.018), with a higher proportion exhibiting albumin-bilirubin score of grade 3 in comparison to that of the non-HPS subjects (27.3% vs. 14%, respectively, P=0.013). Logistic regression analysis identified IL-8 as an independent risk factor for developing HPS (OR=1.05, 95%CI=1.017-1.087, P=0.03). Receiver operating characteristic curve (ROC) analysis indicated that IL-8 demonstrated superior diagnostic efficacy for identifying cases of HPS, with an area under curve (AUC) of 0.695 (95%CI=0.571-0.818, P=0.004) and a specificity rate reaching 0.913. Conclusion Patients diagnosed with hepatopulmonary syndrome are predisposed to hypoxic symptoms alongside increased risks for gastrointestinal bleeding as well as relatively compromised liver function. The level of IL-8 may serve as a crucial biomarker for diagnosing hepatopulmonary syndrome.

Key words: Decompensated cirrhosis stage, Hepatopulmonary syndrome, Clinical manifestations, Gastrointestinal hemorrhage, Albumin, IL-8

GOU Guo-e, ZHANG Meng, YANG Liu, MENG Ting, LI Ya-ping, DANG Shuang-suo. An analysis on the clinical characteristics and associated factors of decompensated cirrhosis complicated by hepatopulmonary syndrome[J]. Chinese Hepatolgy, 2025, 30(10): 1319-1323.

References

[1] Kumar P, Rao P N. Hepatopulmonary syndrome [J]. N Engl J Med, 2020, 382(10): e14.
[2] Han S K, Baik S K, Kim M Y. Pulmonary complications in patients with liver cirrhosis [J]. Korean J Gastroenterol, 2023, 82(5): 213-223.
[3] Bommena S, Gerkin R D, Agarwal S, et al. Diagnosis of hepatopulmonary syndrome in a large integrated health system [J]. Clin Gastroenterol Hepatol, 2021, 19(11): 2370-2378.
[4] Krowka M J, Fallon M B, Kawut S M, et al. International liver transplant society practice guidelines: diagnosis and management of hepatopulmonary syndrome and portopulmonary hypertension [J]. Transplantation, 2016, 100(7): 1440-1452.
[5] Raevens S, Boret M, Fallon M B. Hepatopulmonary syndrome [J]. JHEP Rep, 2022, 4(9): 100527.
[6] Dahiya D S, Kichloo A, Shaka H, et al. Hepatopulmonary syndrome: a nationwide analysis of epidemiological trends and outcomes from 2012 to 2018 [J]. Gastroenterology Res, 2021, 14(4): 252-258.
[7] Morvan A, Gazon M, Duperret S, et al. Hepatopulmonary syndrome and post-liver transplantation complications: a case-control study [J]. Int J Organ Transplant Med, 2020, 11(4): 166-175.
[8] 中华医学会肝病学分会. 肝硬化诊治指南 [J]. 中华肝脏病杂志, 2019, 27(11): 846-865.
[9] 中国成年人超声心动图检查测量指南 [M]. 2016.
[10] 马仁舒. 肝硬化患者中肝肺综合征的相关因素分析 [D]. 吉林大学, 2022.
[11] Kawut S M, Krowka M J, Forde K A, et al. Impact of hepatopulmonary syndrome in liver JXZtransplantation candidates and the role of angiogenesis [J]. Eur Respir J, 2022, 60(2):2102304.
[12] Khiangte B, Kothakota S R, Sasidharan M, et al. Prevalence and determinants of hepatopulmonary syndrome in decompensated chronic liver disease [J]. Indian J Gastroenterol, 2020, 39(4): 362-369.
[13] Furuta Y, Sugahara M, Nakamura T, et al. Platypnea-orthodeoxia: an effective diagnostic tool for hepatopulmonary syndrome with chronic obstructive pulmonary disease [J]. Cureus, 2023, 15(3): e35904.
[14] Vaishnav B, Barla D R, Ruchitha P, et al. Pulmonary dysfunction in patients with cirrhosis of the liver: a study of pulmonary function tests and arterial blood gases [J]. Int J Appl Basic Med Res, 2024, 14(1): 48-53.
[15] Singhai A, Mallik M, Jain P. Unmasking hypoxia in cirrhosis patients: six-minute walk test as a screening tool for hepatopulmonary syndrome [J]. Adv Biomed Res, 2022, 11:50.
[16] Forde K A, Fallon M B, Krowka M J, et al. Pulse oximetry is insensitive for detection of hepatopulmonary syndrome in patients evaluated for liver transplantation [J]. Hepatology, 2019, 69(1): 270-281.
[17] Luo B W, Du Z Y. Advances in diagnostic imaging of hepatopulmonary syndrome [J]. Front Med (Lausanne), 2021, 8:817758.
[18] Engelmann C, Clària J, Szabo G, et al. Pathophysiology of decompensated cirrhosis: portal hypertension, circulatory dysfunction, inflammation, metabolism and mitochondrial dysfunction [J]. J Hepatol, 2021, 75 Suppl 1(Suppl 1): S49-s66.
[19] Yang M, Zhang C Y. Interleukins in liver disease treatment [J]. World J Hepatol, 2024, 16(2): 140-145.
[20] Matsushima K, Yang D, Oppenheim J J. Interleukin-8: An evolving chemokine [J]. Cytokine, 2022, 153:155828.
[21] Zimmermann H W, Seidler S, Gassler N, et al. Interleukin-8 is activated in patients with chronic liver diseases and associated with hepatic macrophage accumulation in human liver fibrosis [J]. PLoS One, 2011, 6(6): e21381.
[22] Liu L, Chen P, Xiao N, et al. Interleukin-8 predicts short-term mortality in acute-on-chronic liver failure patients with hepatitis B-related-related cirrhosis background [J]. Ann Med, 2023, 55(2): 2287708.