Hepatopulmonary syndrome: A prospective study of relationships between severity of liver disease, PaO2 response to 100% oxygen, and brain uptake after 99mTc MAA lung scanning

Michael J. Krowka, Gregory A. Wiseman, Omer L. Burnett, James R. Spivey, Terry Therneau, Michael K. Porayko, Russell H. Wiesner

Research output: Contribution to journalArticle

197 Scopus citations

Abstract

Background: Because of the spectrum of intrapulmonary vascular dilation that characterizes hepatopulmonary syndrome (HPS), PaO2 while breathing 100% oxygen varies. Abnormal extrapulmonary uptake of 99mTc 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) PaO2 while breathing room air (RA) and 100% oxygen on 100% oxygen; and (3) extrapulmonary (brain) uptake of 99mTc MAA after lung scanning. Methods and patients: We prospectively measured PaO2 on RA, PaO2 on 100% oxygen, and brain uptake after lung perfusion of 99mTc MAA in 25 consecutive HPS patients. Results: Mean PaO2 on RA, PaO2 on 100% oxygen, PaCO2 on RA, and 99mTc MAA brain uptake were similar when categorized by CP classification. Brain uptake was abnormal (≥ 6%) in 24 patients (96%). Brain uptake was 29 ± 20% (mean ± SD) and correlated inversely with PaO2 on RA (r = -0.57; p < 0.05) and PaO2 on 100% oxygen (r = -0.41; p < 0.05). Seven patients (28%) had additional nonvascular pulmonary abnormalities and lower PaO2 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 99mTc MAA (48 ± 18% vs 25 ± 20%; p < 0.04) and lower PaO2 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 PaO2 on 100% oxygen. Mortality was associated with lower PaO2 on RA, and with greater brain uptake of 99mTc MAA.

Original languageEnglish (US)
Pages (from-to)615-624
Number of pages10
JournalChest
Volume118
Issue number3
DOIs
StatePublished - Jan 1 2000

Keywords

  • Cirrhosis
  • Hypoxemia
  • Intrapulmonary shunt
  • Liver transplantation
  • Lung scanning

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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