Pulse Oximetry Is Insufficient for Timely Diagnosis of Hepatopulmonary Syndrome in Children with Liver Cirrhosis - 20/02/14
, Simon Raub 1, Ulrich Neudorf, MD 2, Carsten Müntjes, MD 2, Simone Kathemann, MD 1, Elke Lainka, MD 1, Florian Stehling, MD 3, Peter F. Hoyer, MD 1, Patrick Gerner, MD 1Abstract |
Objective |
To prospectively investigate the prevalence of hepatopulmonary syndrome (HPS), the importance of pulse oximetry in diagnosing HPS, and the longitudinal course after liver transplantation in children with cirrhosis referred for liver transplantation.
Study design |
Fifty-six patients aged 1-17 years (mean age, 4.6 ± 5.0 years) with liver cirrhosis were screened for HPS by hyperemic capillary blood gas (CBG) analysis and contrast-enhanced transthoracic echocardiography. Eleven patients were excluded owing to conditions that can produce cardiopulmonary dysfunction, including 5 with cystic fibrosis, 1 with pulmonary arterial hypertension, and 5 with an intracardial shunt. HPS was classified in accordance with the European Respiratory Society Task Force criteria on pulmonary-hepatic disorders. Patient groups were compared for biochemical and clinical characteristics.
Results |
Eighteen children (40%) with cirrhosis were intrapulmonary vasodilatation (IPVD)-positive and had a pulse oximetry oxygen saturation level >98%. Two of these patients (11%) exhibited moderate HPS with an elevated alveolar arterial oxygen gradient >15 mm Hg and PaO2 <70 mm Hg; they died before undergoing liver transplantation. The sensitivity and specificity of CBG analysis for detecting elevated alveolar arterial oxygen gradient in children with IPVD was 94% and 53%, respectively. HPS was associated with late hepatoportoenterostomy (P < .04). Liver transplantation led to resolution of HPS in all patients.
Conclusion |
IPVD is frequent in children with liver cirrhosis (40%). Pulse oximetry is insufficient for timely HPS diagnosis. Pathological CBG analysis data indicate IPVD in the majority of cases, but are imprecise in children aged <2 years. Contrast-enhanced transthoracic echocardiography and CBG analysis are recommended for evaluation of HPS in children with cirrhosis, regardless of liver synthesis capacity and clinical chemistry data.
Le texte complet de cet article est disponible en PDF.Keyword : ABG, CBG, cTTE, HPS, IPVD, PΔAaO2, SO2
Plan
| The authors declare no conflicts of interest. |
Vol 164 - N° 3
P. 546 - mars 2014 Retour au numéro
Article précédent
- Prevalence of Functional Gastrointestinal Disorders in Colombian School Children
- Miguel Saps, Diana X. Nichols-Vinueza, John M. Rosen, Carlos Alberto Velasco-Benítez
- Clinical and Molecular Characteristics of Mitochondrial DNA Depletion Syndrome Associated with Neonatal Cholestasis and Liver Failure
- Abdulrahman Al-Hussaini, Eissa Faqeih, Ayman W. El-Hattab, Majid Alfadhel, Ali Asery, Badr Alsaleem, Eman Bakhsh, Ashraf Ali, Ali Alasmari, Khurram Lone, Ahmed Nahari, Wafaa Eyaid, Mohammed Al Balwi, Kate Craig, Anna Butterworth, Langping He, Robert W. Taylor
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?