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Krowka MJ, Wiseman GA, Burnett OL, Spivey JR, Therneau T, Porayko MK, Wiesner RH: Hepatopulmonary syndrome: a prospective study of relationships between severity of liver disease, PaO (2) response to 100% oxygen, and brain uptake after (99m) Tc MAA lung scanning. Chest. 2000 Sep;118(3):615-24.
BACKGROUND: Because of the spectrum of intrapulmonary vascular dilation that characterizes hepatopulmonary syndrome (HPS), PaO (2) while breathing 100% oxygen varies. Abnormal extrapulmonary uptake of (99m) Tc macroaggregated albumin (MAA) after lung perfusion is common. GOAL: To describe relationships between (1) severity of liver disease measured by the Child-Pugh (CP) classification; (2) PaO (2) while breathing room air (RA) and 100% oxygen on 100% oxygen; and (3) extrapulmonary (brain) uptake of (99m) Tc MAA after lung scanning. Methods and patients: We prospectively measured PaO (2) on RA, PaO (2) on 100% oxygen, and brain uptake after lung perfusion of (99m) Tc MAA in 25 consecutive HPS patients. RESULTS: Mean PaO (2) on RA, PaO (2) on 100% oxygen, PaCO (2) on RA, and (99m) Tc MAA brain uptake were similar when categorized by CP classification. Brain uptake was abnormal (> or = 6%) in 24 patients (96%). Brain uptake was 29 +/- 20% (mean +/- SD) and correlated inversely with PaO (2) on RA (r = -0.57; p <0.05) and PaO (2) on 100% oxygen (r = -0.41; p <0.05). Seven patients (28%) had additional nonvascular pulmonary abnormalities and lower PaO (2) on 100% oxygen (215+/-133 mm Hg vs 391+/-137 mm Hg; p <0.007). Eight patients (32%) died. Mortality in patients without coexistent pulmonary abnormalities was associated with greater brain uptake of (99m) Tc MAA (48+/-18% vs 25+/-20%; p <0.04) and lower PaO (2) on RA (40+/-7 mm Hg vs 57+/-11 mm Hg; p <0.001). CONCLUSION: The degree of hypoxemia associated with HPS was not related to the CP severity of liver disease. HPS patients with additional nonvascular pulmonary abnormalities exhibited lower PaO (2) on 100% oxygen. Mortality was associated with lower PaO (2) on RA, and with greater brain uptake of (99m) Tc MAA. |
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