Utility of pulse oximetry screening for hepatopulmonary syndrome

Background & Aims: Hepatopulmonary syndrome is characterized by oxygenation abnormalities caused by intrapulmonary vasodilatation in the setting of liver disease and/or portal hypertension. This syndrome occurs in approximately 15%-30% of cirrhotic patients and influences mortality and transplant candidacy. However, no specific screening guidelines are established. We evaluated pulse oximetry with contrast echocardiography in detecting hepatopulmonary syndrome in a cohort of patients undergoing evaluation for liver transplantation. Methods: One hundred twenty-seven consecutive patients referred for liver transplantation evaluation were prospectively enrolled and underwent pulse oximetry, contrast echocardiography, and arterial blood gas measurements on room air. Demographic, clinical, and laboratory data were recorded and analyzed. Results: Forty-one (32%) patients were found to have hepatopulmonary syndrome. There were no significant differences in demographic or clinical features compared with patients without hepatopulmonary syndrome, with the exception of pulse oximetry and oxygenation abnormalities. With a threshold value of < 96%, pulse oximetry had a sensitivity and specificity of 100% and 88%, respectively, for detecting patients with a partial pressure of oxygen < 60 mm Hg. Receiver operator characteristic analysis revealed that a pulse oximetry value of <= 594% detected all patients with a partial pressure of oxygen < 60 mm Hg with an increased specificity of 93%. In addition, higher pulse oximetry thresholds reliably identified HPS patients with less severe hypoxemia, albeit with lower specificity. Conclusions: Pulse oximetry is a simple, low cost, and widely available technique that reliably predicts the presence and severity of hypoxemia in patients with hepatopulmonary syndrome. Institution of pulse oximetry screening might enhance detection and improve management of hepatopulmonary syndrome in cirrhosis.