PREVALÊNCIA DA SÍNDROME HEPATOPULMONAR EM PACIENTES CIRRÓTICOS CANDIDATOS AO TRANSPLANTE HEPÁTICO

Abstract

Hepatopulmonary Syndrome (HPS) is a pulmonary complication of chronic liver disease, defined by the presence of the triad: liver cirrhosis, impairment of arterial oxygenation and intrapulmonary vascular dilatations (IPVD). The lack of consensus on diagnostic criteria and thresholds implies a wide and imprecise prevalence range for HPS, from 4% to 32%, which is a limiting factor for studies regarding the most appropriate therapeutic approaches and the assessment of the prognosis of these patients. Objective: to evaluate the prevalence of Hepatopulmonary Syndrome in moderate/severe cirrhotic patients at the Lauro Wanderley University Hospital of the Federal University of Paraíba (HULW-UFPB), as well as to characterize the demographic profile, assess changes in gas exchange, intrapulmonary vasodilatation and severity from SHP. Methodology: 48 patients with moderate/severe cirrhosis were evaluated for HPS, between October/2021 and March/2023, at the University Hospital Lauro Wanderley of the Federal University of Paraíba (HULW-UFPB). As diagnostic criteria for HPS, alveolar-arterial oxygen gradient ≥ 15 mmHg or ≥ 20 mmHg if age > 64 years, associated with detection, by transthoracic echocardiography, of microbubbles in the left heart chambers between the fourth and sixth cardiac cycle. Results: HPS was observed in 3 patients (4.25%). The mean age was 59.3 years (SD ± 13.14), 34 (70.8%) were male, the alcoholic etiology of liver cirrhosis was the most frequent (60.4%) and, in terms of severity , class B (63.0%) of the Child-Pugh classification and the score range between 10 and 19 (47.6%) of the MELD-Na score were the most frequent. 14.5% of the patients had impairment of arterial oxygenation in the screening with pulse oximetry. Conclusion: the prevalence of HPS in the study sample was 4.25%, corresponding to the literature. The demographic profile showed a higher frequency of males, aged between 60-69 years, alcoholic etiology and moderate degree of liver dysfunction.