Prevalence of Portopulmonary Hypertension in Patients with Hepatic Cirrhosis

Umar Javaid Sandhu; Ayesha Chaudhary; Ahmad Salman Jami; Hafiz Bilal Wajid; Farah Shakeel; Gull Seira

doi:10.70749/ijbr.v3i7.1674

Authors

Umar Javaid Sandhu Department of Medicine, Ghurki Trust Teaching Hospital, Lahore, Punjab, Pakistan.
Ayesha Chaudhary Department of Medicine, Allied Hospital, Faisalabad, Punjab, Pakistan.
Ahmad Salman Jami Department of Medicine, Ghurki Trust Teaching Hospital, Lahore, Punjab, Pakistan.
Hafiz Bilal Wajid Department of Medicine, Ghurki Trust Teaching Hospital, Lahore, Punjab, Pakistan.
Farah Shakeel Department of Medicine, Ghurki Trust Teaching Hospital, Lahore, Punjab, Pakistan.
Gull Seira Department of Medicine, Ghurki Trust Teaching Hospital, Lahore, Punjab, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v3i7.1674

Keywords:

Portopulmonary Hypertension, Hepatic Cirrhosis

Abstract

Objective: “To determine the frequency of portopulmonary hypertension in patients with hepatic cirrhosis.” Study Place and Duration: Department of Medicine, Ghurki Trust Teaching Hospital, Lahore for 05 months from 7th Feb 2025 to 8th June 2025. Methodology: After meeting the selection criteria, 130 patients were and underwent portal vein Doppler ultrasound and echocardiography. Portopulmonary hypertension was diagnosed if the patient had a tricuspid regurgitation velocity ≥2.8 m/s, an estimated pulmonary artery systolic pressure >35 mmHg on echocardiography, pulmonary arterial pressure >20 mmHg, pulmonary artery wedge pressure ≤15 mmHg, and pulmonary vascular resistance ≥3 Wood units. All findings were documented in a structured proforma and analysed in SPSS. Results: The mean age of participants was 55.40  ±  9.76 years. Among them, 71 (54.6%) were male and 59 (45.4%) were female. In this study, porto-pulmonary hypertension was observed in 14 patients (10.77%) with hepatic cirrhosis. Among males, 4 (5.6%) had portopulmonary hypertension, compared to 10 (16.9%) females (p = 0.038*). Conclusion: Based on the findings of this study, it can be concluded that portopulmonary hypertension was present in 10.77% of patients with hepatic cirrhosis, with a higher prevalence observed among females.

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References

Enenche, A. A., Kweki, A., Aiwuyo, H. O., Akinti, O., Nevolina, A., Perry, J. C., Ayinalem, Y., Osarenkhoe, J. O., Ukenenye, E., Poluyi, C. O., & Ibrahim, A. O. (2024). Prevalence of pulmonary hypertension in liver cirrhosis patients: A cross-sectional analytical study. Cureus.

https://doi.org/10.7759/cureus.57313

Savale, L., Guimas, M., Ebstein, N., Fertin, M., Jevnikar, M., Renard, S., Horeau-Langlard, D., Tromeur, C., Chabanne, C., Prevot, G., Chaouat, A., Moceri, P., Artaud-Macari, É., Degano, B., Tresorier, R., Boissin, C., Bouvaist, H., Simon, A., Riou, M., … Sitbon, O. (2020). Portopulmonary hypertension in the current era of pulmonary hypertension management. Journal of Hepatology, 73(1), 130-139.

https://doi.org/10.1016/j.jhep.2020.02.021

Atsukawa, M., Tsubota, A., Hatano, M., Kondo, C., Shioda, K., Ohno, H., Kawano, T., Hayama, K., Arai, T., Nakagawa‐Iwashita, A., Itokawa, N., Kaneko, K., Yoshida, Y., Koeda, M., Okubo, T., Yamamoto, T., Yamamoto, T., Taniai, N., Yoshida, H., … Iwakiri, K. (2020). Prevalence and characteristics of portopulmonary hypertension in cirrhotic patients who underwent both hepatic vein and pulmonary artery catheterization. Hepatology Research, 50(11), 1244-1254.

https://doi.org/10.1111/hepr.13560

Navarro-Vergara, D. I., Roldan-Valadez, E., Cueto-Robledo, G., & Jurado-Hernandez, M. Y. (2021). Portopulmonary hypertension: Prevalence, clinical and hemodynamic features. Current Problems in Cardiology, 46(3), 100747.

https://doi.org/10.1016/j.cpcardiol.2020.100747

Lai, Y. K., & Kwo, P. Y. (2023). Portopulmonary hypertension. Clinics in Liver Disease, 27(1), 71-84.

https://doi.org/10.1016/j.cld.2022.08.002

Jasso-Baltazar, E. A., Peña-Arellano, G. A., Aguirre-Valadez, J., Ruiz, I., Papacristofilou-Riebeling, B., Jimenez, J. V., García-Carrera, C. J., Rivera-López, F. E., Rodriguez-Andoney, J., Lima-Lopez, F. C., Hernández-Oropeza, J. L., Díaz, J. A., Kauffman-Ortega, E., Ruiz-Manriquez, J., Hernández-Reyes, P., Zamudio-Bautista, J., Rodriguez-Osorio, C. A., Pulido, T., Muñoz-Martínez, S., … García-Juárez, I. (2023). Portopulmonary hypertension: An updated review. Transplantation Direct, 9(8), e1517.

https://doi.org/10.1097/txd.0000000000001517

Frost, A., Badesch, D., Gibbs, J. S., Gopalan, D., Khanna, D., Manes, A., Oudiz, R., Satoh, T., Torres, F., & Torbicki, A. (2018). Diagnosis of pulmonary hypertension. European Respiratory Journal, 53(1), 1801904.

https://doi.org/10.1183/13993003.01904-2018

Weatherald, J., Boucly, A., Chemla, D., Savale, L., Peng, M., Jevnikar, M., Jaïs, X., Taniguchi, Y., O’Connell, C., Parent, F., Sattler, C., Hervé, P., Simonneau, G., Montani, D., Humbert, M., Adir, Y., & Sitbon, O. (2018). Prognostic value of follow-up hemodynamic variables after initial management in pulmonary arterial hypertension. Circulation, 137(7), 693-704.

https://doi.org/10.1161/circulationaha.117.029254

Shao, Y., Yin, X., Qin, T., Zhang, R., Zhang, Y., & Wen, X. (2021). Prevalence and associated factors of Portopulmonary hypertension in patients with Portal hypertension: A case‐control study. BioMed Research International, 2021(1).

https://doi.org/10.1155/2021/5595614

Simonneau, G., Montani, D., Celermajer, D. S., Denton, C. P., Gatzoulis, M. A., Krowka, M., Williams, P. G., & Souza, R. (2019). Haemodynamic definitions and updated clinical classification of pulmonary hypertension. European Respiratory Journal, 53(1), 1801913.

https://doi.org/10.1183/13993003.01913-2018

Ruopp, N. F., & Cockrill, B. A. (2022). Diagnosis and treatment of pulmonary arterial hypertension. JAMA, 327(14), 1379.

https://doi.org/10.1001/jama.2022.4402

Delcroix, M., Torbicki, A., Gopalan, D., Sitbon, O., Klok, F. A., Lang, I., Jenkins, D., Kim, N. H., Humbert, M., Jais, X., Vonk Noordegraaf, A., Pepke-Zaba, J., Brénot, P., Dorfmuller, P., Fadel, E., Ghofrani, H., Hoeper, M. M., Jansa, P., Madani, M., … Simonneau, G. (2020). ERS statement on chronic thromboembolic pulmonary hypertension. European Respiratory Journal, 57(6), 2002828.

https://doi.org/10.1183/13993003.02828-2020

Gupta, A., Pradhan, A., Mehrotra, S., Misra, R., Usman, K., Kumar, A., & Pandey, S. (2022). Prevalence and clinical features of Portopulmonary hypertension in patients with hepatic cirrhosis: An Echocardiographic study. Cureus.

https://doi.org/10.7759/cureus.24957

Poordad, F. F. (2015). Presentation and complications associated with cirrhosis of the liver. Current Medical Research and Opinion, 31(5), 925-937.

https://doi.org/10.1185/03007995.2015.1021905

Shah, N., Pourkazemi, Y., Hojnowski, K., & Cornella, S. (2015). Management options in decompensated cirrhosis. Hepatic Medicine: Evidence and Research, 43.

https://doi.org/10.2147/hmer.s62463

Ahmad G, Butt NI, Ashfaq F, Khan AA, Nazir M, Raheem R. Prevalence of pulmonary hypertension in patients of chronic liver disease. Rawal Medical Journal. 2021;46(4):792-4

Bozbas, S., & Eyuboglu, F. (2011). Evaluation of liver transplant candidates: A pulmonary perspective. Annals of Thoracic Medicine, 6(3), 109.

https://doi.org/10.4103/1817-1737.82436

Gurghean, A. V., & Tudor, I. A. (2017). Pulmonary hypertension in patients with hepatic cirrhosis and Portal hypertension. An echographic study. Medicine and Pharmacy Reports, 90(2), 161-165.

https://doi.org/10.15386/cjmed-705

Chiva, T., Ripoll, C., Sarnago, F., Rincón, D., Gómez‐Camarero, J., Galindo, E., Catalina, M., Elizaga, J., & Bañares, R. (2014). Characteristic haemodynamic changes of cirrhosis may influence the diagnosis of portopulmonary hypertension. Liver International, 35(2), 353-361.

https://doi.org/10.1111/liv.12562

CHEN, H., XING, S., XU, W., YANG, F., QI, X., WANG, L., & YANG, C. (2013). Portopulmonary hypertension in cirrhotic patients: Prevalence, clinical features and risk factors. Experimental and Therapeutic Medicine, 5(3), 819-824.

https://doi.org/10.3892/etm.2013.918

Kawut, S. M., Krowka, M. J., Trotter, J. F., Roberts, K. E., Benza, R. L., Badesch, D. B., Taichman, D. B., Horn, E. M., Zacks, S., Kaplowitz, N., Brown, R. S., & Fallon, M. B. (2008). Clinical risk factors for portopulmonary hypertension†. Hepatology, 48(1), 196-203.

https://doi.org/10.1002/hep.22275

Al‐Naamani, N., Krowka, M. J., Forde, K. A., Krok, K. L., Feng, R., Heresi, G. A., Dweik, R. A., Bartolome, S., Bull, T. M., Roberts, K. E., Austin, E. D., Hemnes, A. R., Patel, M. J., Oh, J. K., Lin, G., Doyle, M. F., Denver, N., Andrew, R., & MacLean, M. R. (2020). Estrogen signaling and Portopulmonary hypertension: The pulmonary vascular complications of liver disease study (PVCLD2). Hepatology, 73(2), 726-737.

https://doi.org/10.1002/hep.31314

Nadeem, M. A., Waseem, T., Sheikh, A. M., Grumman, N., Irfan, K., & Hasnain, S. S. (2002). Hepatitis C virus: an alarmingly increasing cause of liver cirrhosis in Pakistan. Pak J Gastroenterol, 16(1), 3-8.

Farooqi, R. J., Farooqi, J. I., ur Rehman, M., Ahmad, H., Ahmad, F., & Gul, S. (2005). Outcome after injection sclerotherapy for esophageal variceal bleeding in patients with liver cirrhosis and COPD. Journal of Postgraduate Medical Institute, 19(1).

Intekhab, A., Iqbal, H., M Amjad, T., & Muhammad, N. (2005). Spectrum of precipitating factors of hepatic encephalopathy in liver cirrhosis. Pak J Med Res. 2005;44(2):96-100.

https://pesquisa.bvsalud.org/portal/resource/pt/emr-74340