Arterial hypoxemia in patients with cirrhosis of liver.

Introduction: Mild hypoxia has been seen in approximately one third of patients with chronic liver disease. Development of hypoxemia in patients with chronic liver disease, modifies the line of management and worsens the prognosis of the disease. Hence an early detection of hypoxemia in these patients is essential. Hypoxemia results from various causes in patients with chronic liver disease. Hepato pulmonary syndrome is an important cause in a patient with hypoxemia and chronic liver disease. Development of this complication in chronic liver disease indicates a poorer prognosis in these patients. Chronic liver disease is also known to be associated with pulmonary manifestations that affect both the pleural space and lung parenchyma. This study was undertaken to study the prevalence of hypoxemia and assess the prognosis in patients with chronic liver disease.

Materials And Methods: Fourty three patients aged 18 years and above with evidence of cirrhosis, admitted under the department of Medicine and Gastroenterology, were included in the study. A detailed history was taken and clinical examination were done in all patients. All patients underwent ultrasonography, LFT, biochemical tests and upper gastrointestinal endoscopy to confirm chronic liver disease, portal hypertension and varices, if any chest X-ray, 2-D transthoracic echocardiogram, viral studies and pulmonary function tests. The patients in whom arterial hypoxemia was detected with a positive contrast echocardiogram were considered to have hepato pulmonary syndrome.

Results: Six out of the 43 patients (13.9%) included in the study had hypo-xemia. Among these 6 patients with hypoxemia, 3 were found to have contrast enhanced echocardiographic evidence of intra pulmonary vascular dilatations and diagnosed hepato pulmonary syndrome. The other 3 patients had evidence of both, interstitial lung disease and pleural effusion contributing to hypoxemia. The patients with hepato pulmonary syndrome had a significant P (A-a) O2 gradient, died during the study period, indicating a poorer prognosis.

Conclusions: We conclude that identification of hypoxemia and its aetiology in patients with chronic liver disease is essential. Identification of hepato pulmonary syndrome is important, as it carries a poor prognosis in patients with chronic liver disease.