Evolution of hypoxemia in patients with severe cirrhosis.

BACKGROUND AND AIM

Hypoxemia is common in patients with cirrhosis but the natural history of this syndrome is unknown. The aim of this study was to follow a series of patients with cirrhosis and to compare patients with and without hypoxemia to determine their risk of complications and survival rate.

METHODS

Fifty-eight consecutive Child-Pugh C patients with cirrhosis were included and followed up for 1-18 months. Blood gas measurements and plasma endothelin levels were measured in all patients. Blood gas measurements were repeated in 34 patients.

RESULTS

Hypoxemia was present in 35 patients (60%) (alveolar-arterial oxygen (AaO2) gradient > 20 mmHg) but none had pulmonary symptoms. There was no significant difference in liver tests and plasma endothelin levels between hypoxemic and non-hypoxemic patients. The occurrence of variceal bleeding and survival rate was not significantly different between the two groups. The AaO2 gradient worsened in nine patients and normalized in six of the hypoxemic patients. The AaO2 gradient increased to more than 20 mmHg in seven non-hypoxemic patients. There was no relationship between AaO2 gradient changes and Child-Pugh score grade changes.

CONCLUSION

Asymptomatic hypoxemia is common in patients with severe cirrhosis but it is not a predictive factor of short-term complications or mortality. These results should be considered when deciding on liver transplantation.