NATIONAL JOURNAL OF MEDICAL RESEARCH print ISSN: 2249 4995eISSN: 2277 8810 NJMRVolume 6Issue 3July – Sep 2016 Page 275 ORIGINAL ARTICLE FREQUENCY AND PREDICTORS OF HEPATOPULMONARY SYNDROME IN CHRONIC LIVER DISEASE PATIENTS Atanu Chandra 1 , Soumya S Mondal 2 , Sanjay K Mandal 3 , Indranil Sen 1 , Mithun Das 1 , Snigdhendu Pal 1 Author’s Affiliations: 1 Resident, 2 Associate Professor, 3 Professor, Medical College, Kolkata Correspondence: Dr Atanu Chandra 1 Email: sanjaypgcal@yahoo.co.in ABSTRACT Introduction: Hepatopulmonary syndrome is not very uncommon among chronic liver disease patients in clinical practice.It is associated with shorter survival and poor liver function in cirrhotics. Although there are a large number of CLD patients in India, the exact frequency of HPS is not known & it needs evaluation. Aims: To estimate the frequency of hepatopulmonary syndrome among Indian patients with chronic liver disease, study the correlation between HPS and the severity of liver disease and assess the factors predictive for diagnosis of HPS. Methodology: A cross sectional study on total fifty patients (34 males, mean age 44.4 ± 7.3years) with chronic liver disease was conducted to diagnose the presence of hepatopulmonary syndrome. Patients were subjected to clinical examination, laboratory investigations, measurement of arterial blood gas and transthoracic contrast enhanced echocardiography. The severity of liver disease was assessed by Child-Pugh score.The diagnostic criteria for HPS were presence of intrapulmonary vascular dilatation(IPVD) documented by contrast enhanced echocardiography and alveolar arterial oxygen gradient of more than 15 mm Hg. Results:.Nine of fifty patients (18%) with chronic liver diseas were found to have contrast echocardiographic evidence of intrapulmonary vasodilatation. Hepatopulmonary syndrome was observed in seven (14%) patients.We did not find any significant correlation between presence of HPS with severity of liver disease according to the Child-Pugh score. Features like dyspnoea, orthopnea, cyanosis, clubbing, platypnoea and orthodeoxia were significantly more common in the HPS group. Conclusions: The frequency of HPS among the studied group of Indian patients with chronic liver disease was 14%. Though there was no significant correlation between presence of HPS with severity of liver disease according to the Child-Pugh score ; but presence of cyanosis, clubbing, dyspnoea and platypnoea– orthodeoxia are suggestive indicators of HPS. Keywords: Hepatopulmonary Syndrome, Chronic Liver Disease, Dyspnoea, Orthopnea, Cyanosis, Clubbing INTRODUCTION Hepatopulmonary syndrome is a very important complication in patients with cirrhosis and portal hypertension due to alteration in pulmonary vasculature by different mechanisms. It is characterized by the triad of chronic liver disease, namely cirrhosis and/or portal hypertension;features of arterial deoxygenation and presence of intrapulmonary vascular dilatations (IPVD). 1,2,3 This syndrome is frequently underdiagnosed,mostly in early stages,due to the fact that most of the affected patients are either asymptomatic or present with vague complaints of shortness of breath and easy fatiguability. 4 HPS is reported to occur in 11% to 32% of the patients with chronic liver disease (CLD), mainly cirrhotic patients. 5,6,7,8 Clinical features like dyspnea, cyanosis, platypnea, spider nevi and clubbing are more frequent in patients with HPS when compared to those without HPS [3,7] It should also be mentioned that HPS is associated with more severe CLD, assessed either by the Child-Pugh (CP) score or by the Model for End- Stage Liver Disease (MELD) score, in some but not all the studies. 4,5,9,10 The natural course of HPS was generally progressive and it was associated with shortened survival. No effective medical therapies are available for HPS, although liver transplantation reverses the syndrome in most patients. 11,12 The objective of the present study was to determine the prevalence of HPS in a sample of Indian patients with chronic liver disease and to compare clinical, and laboratory characteristics in patients with and without HPS.