{"id":84,"date":"2009-02-28T14:42:45","date_gmt":"2009-02-28T14:42:45","guid":{"rendered":"https:\/\/medicalcriteria.com\/web\/pulhps\/"},"modified":"2025-05-14T20:58:05","modified_gmt":"2025-05-14T20:58:05","slug":"pulhps","status":"publish","type":"post","link":"https:\/\/medicalcriteria.com\/web\/pulhps\/","title":{"rendered":"Diagnostic Criteria for the Hepatopulmonary Syndrome (HPS)"},"content":{"rendered":"<div class=\"99c380e4b4a7b96c35d7ddf7dcb434e8\" data-index=\"1\" style=\"float: none; margin:0px 0 0px 0; text-align:center;\">\n<script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script>\r\n<!-- MC 2019- Horizontal -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-0127150553352455\"\r\n     data-ad-slot=\"3806776041\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\n<\/div>\n<p>The hepatopulmonary syndrome is characterized as the triad of liver disease, pulmonary gas exchange abnormalities leading to arterial deoxygenation and evidence of intrapulmonary vascular dilatations.<br \/>\n<!--more--><\/p>\n<table style=\"border-collapse: collapse; width: 100%;\" border=\"1\">\n<tbody>\n<tr>\n<td style=\"width: 29.6364%;\"><strong>Variable<\/strong><\/td>\n<td style=\"width: 70.3636%;\"><strong>Criterion<\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 29.6364%;\">Oxygenation defect<\/td>\n<td style=\"width: 70.3636%;\">Partial pressure of oxygen &lt;80 mm Hg or alveolar\u2013arterial oxygen gradient \u226515 mm Hg while breathing ambient air<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 29.6364%;\">Pulmonary vascular dilatation<\/td>\n<td style=\"width: 70.3636%;\">Positive findings on contrast-enhanced echocardiography or abnormal uptake in the brain (&gt;6%) with radioactive lung-perfusion scanning<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 29.6364%;\">Liver disease<\/td>\n<td style=\"width: 70.3636%;\">Portal hypertension (most common) with or without cirrhosis<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p><strong>Degree of severity<\/strong><\/p>\n<ul>\n<li>Mild: Alveolar\u2013arterial oxygen gradient \u226515 mm Hg, partial pressure of oxygen \u226580 mm Hg<\/li>\n<li>Moderate: Alveolar\u2013arterial oxygen gradient \u226515 mm Hg, partial pressure of oxygen \u226560 to &lt;80 mm Hg<\/li>\n<li>Severe: Alveolar\u2013arterial oxygen gradient \u226515 mm Hg, partial pressure of oxygen \u226550 to &lt;60 mm Hg<\/li>\n<li>Very severe: Alveolar\u2013arterial oxygen gradient \u226515 mm Hg, partial pressure of oxygen &lt;50 mm Hg (&lt;300 mm Hg while the patient is breathing 100% oxygen)<\/li>\n<\/ul>\n<p class=\"MsoNormal\" align=\"justify\">All criteria were determined by means of positive contrast-enhanced echocardiography (i.e., microbubble opacification of the left heart chambers three to six cycles after right atrial passage). The abbreviated formula for the alveolar\u2013arterial gradient is as follows:<\/p>\n<p class=\"MsoNormal\" align=\"justify\">PAO<sub>2<\/sub>-PaO<sub>2<\/sub> = (FIO<sub>2<\/sub> [P<sub>atm<\/sub>\u2013PH<sub>2<\/sub>O] \u2013 [PaCO<sub>2<\/sub>\/0.8]) \u2013 PaO<sub>2<\/sub>,<\/p>\n<p class=\"MsoNormal\" align=\"justify\">where PAO<sub>2<\/sub> denotes partial pressure of alveolar oxygen, PaO<sub>2<\/sub> partial pressure of arterial oxygen, FIO<sub>2<\/sub> fraction of inspired oxygen, P<sub>atm<\/sub> atmospheric pressure, PH<sub>2<\/sub>O partial pressure of water vapor at body temperature, and PaCO<sub>2<\/sub> partial pressure of arterial carbon dioxide (0.8 corresponds to the standard gas-exchange respiratory ratio at rest); the normal range is 4 to 8 mm Hg (0.5 to 1.1 kPa). The normal range for the partial pressure of oxygen is 80 to 100 mm Hg (10.7 to 13.3 kPa) at sea level, while the patient is at rest and breathing ambient air. For patients older than 64 years of age, a value of ?70 mm Hg (9.3 kPa) for PaO<sub>2<\/sub> or ?20 mm Hg for the alveolar-arterial gradient is often used. Ambient air is the respired gas unless otherwise indicated. To convert millimeters of mercury to kilopascals, multiply by 0.133.<\/p>\n<p>&nbsp;<\/p>\n<p class=\"MsoNormal\"><strong>References:<\/strong><\/p>\n<div class=\"Section1\">\n<ol>\n<li class=\"MsoNormal\">Rodr\u00edguez-Roisin R, Krowka MJ, Herv\u00e9 P, Fallon MB; ERS Task Force Pulmonary-Hepatic Vascular Disorders (PHD) Scientific Committee. Pulmonary-Hepatic vascular Disorders (PHD). Eur Respir J. 2004 Nov;24(5):861-80. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/15516683\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li class=\"MsoNormal\">Rodriguez-Roisin R, Krowka MJ. Hepatopulmonary Syndrome &#8211; A Liver-Induced Lung Vascular Disorder. N Engl J Med. 2008 May 29;358(22): 2378-2387 <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/18509123\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<\/ol>\n<\/div>\n<p>&nbsp;<\/p>\n<p>Created: May 31, 2008<\/p>\n\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div>","protected":false},"excerpt":{"rendered":"<p>Sorry, this entry is only available in Espa\u00f1ol.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"no","_lmt_disable":"no","_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[233],"tags":[16,15,14,1413,1745,1744,1743,29,5,4],"class_list":["post-84","post","type-post","status-publish","format-standard","hentry","category-pulmonary","tag-criteria","tag-criterios","tag-diagnostic","tag-gastroenterology","tag-hepatopulmonar","tag-hepatopulmonary","tag-hps","tag-pulmonary","tag-sindrome","tag-syndrome"],"modified_by":"Guillermo Firman","_links":{"self":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/84","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/comments?post=84"}],"version-history":[{"count":6,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/84\/revisions"}],"predecessor-version":[{"id":9457,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/84\/revisions\/9457"}],"wp:attachment":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/media?parent=84"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/categories?post=84"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/tags?post=84"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}