PORTO PULMONARY HYPERTENSION AND CIRRHOSIS OF LIVER: AN ASSESSMENT OF ITS FREQUENCY AND ASSOCIATED RISK FACTORS

Abstract

Objectives: To determine the frequency and factors leading to of portopulmonary hypertension among cirrhosis of liver patients

Methodology: One hundred and eleven (111) patients previously diagnosed with cirrhosis of liver due to any cause were included in the study from 15^th June 2016 till 14^th July 2017. All of the patients had echocardiography done. Portopulmonary Hypertension (PoPH) was diagnosed by Echocardiographic signs as per recommendation of European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Tricuspid Regurgitation Velocity of >3.4 m/s Or Tricuspid Regurgitation Velocity of >2.9 m/s but <3.4m/s along with one of the following signs :Right ventricle / left ventricle basal diameter ratio >1, Pulmonary artery diameter > 25 mm, early diastolic pulmonary regurgitation velocity >2.2, m/s Inferior cava diameter >21mm with decreased inspiratory collapse (<50% with a sniff or <20% with quiet inspiration), Flattening of the interventricular septum.

Results: Out of 111 patients, 70 (63%) were male and 41(37%) were female. The mean age of the patients was 51±8.7 years. The cause of cirrhosis noted in the documents at the time of diagnosis was chronic hepatitis C in 62/111 patients (55.85%), chronic hepatitis B in 34/111 (30.63%), alcoholic cirrhosis in 4/111 (3.6%), autoimmune hepatitis in 3/111 (2.7%) and cryptogenic cirrhosis in 1/111(1%). After echocardiography 08 (4 males and 4 females ) out of 111 patients (7.2%) were diagnosed as having Portopulomonary Hypertension (PoPH) and low hemoglobin level was linked autonomously with hazard of PoPH

Conclusion: Viral related cirrhosis is the most common cause of cirrhosis in this part of the world. Echocardiographically confirmed Portopulomonary Hypertension (PoPH) is well reported cardiopulmonary complication of cirrhosis of liver. Among various risk factors for PoPH low haemoglobin (anaemia) was found to be a significant risk factor. Portopulmonary Hypertension (PoPH) is a very important contributing factor in morbidity and mortality in patients of cirrhosis which needs to be identified and confirmed before referring any patient of cirrhosis for Liver Transplant