Comparison of Two Diagnostic Criteria for Hepatopulmonary Syndrome–High Prevalence in Biliary Atresia. Issue 5 (May 2020)

• Record Type: Journal Article
• Authors: Snehavardhan, Pandey; Khanna, Rajeev; Lal, Bikrant B.; Sood, Vikrant; Sood, Arun K.; Alam, Seema
• Is Part Of: Journal of pediatric gastroenterology and nutrition. Volume 70:Issue 5(2020)
• Publication Date: 2020-05
• Subjects: biliary atresia -- chronic liver disease -- diagnostic criteria -- hepatopulmonary syndrome; Children -- Nutrition -- Periodicals; Pediatric gastroenterology -- Periodicals; Infants -- Nutrition -- Periodicals; Nutrition disorders in children -- Periodicals; Child Nutrition -- Periodicals; Digestive System -- growth & development -- Periodicals; Gastrointestinal Diseases -- Periodicals; Infant Nutrition -- Periodicals; Nutrition Disorders -- Periodicals; Child; 618.923
• DOI: 10.1097/MPG.0000000000002621
• Languages: English
• ISSNs: 0277-2116

Abstract

ABSTRACT: Objectives: There is lack of clarity regarding the exact prevalence of hepatopulmonary syndrome (HPS) in pediatric liver diseases owing to lack of standardized diagnostic criteria. Thus, we aimed to do a comparative study of HPS with respect to its prevalence using the available diagnostic criteria. Methods: All consecutive children with biliary atresia (BA) and other chronic liver diseases (CLDs) were studied. Prevalence of HPS was compared using the 2 available criteria: demonstration of intrapulmonary vascular dilatation along with either alveolar-arterial oxygen difference (P [A-a] O2 ) on arterial blood gas analysis of more than 15 mmHg (criteria 1), or higher than age-appropriate calculated value for P (A-a) O2 (criteria 2). Results: A total of 42 children in BA group and 62 in the non-BA CLD group were included. Using the criteria 1, the prevalence of HPS was 42.3%: 57.1% in the BA group and 32.2% in the CLD group, whereas using criteria 2, the prevalence was 48.1%: 61.9% in the BA group and 38.7% in the CLD group. Criteria 2 diagnosed 6 additional patients with HPS compared to criteria 1 ( P value 0.405). BA subjects had higher risk (2.9–3 folds) of developing HPS compared to other CLDs. Conclusion: There is high prevalence of HPS in pediatric liver disease subjects. Age-appropriate formula for HPS diagnosis may be better applicable in pediatric population. BA subjects have a higher risk of developing HPS compared to other CLDs overall, irrespective of the severity of liver disease and/or portal hypertension. Abstract : Supplemental Digital Content is available in the text