Randomized Controlled Trial

. 2023 Feb;17(1):139-149.

doi: 10.1007/s12072-022-10456-y. Epub 2022 Dec 7.

Risk factors for portopulmonary hypertension in patients with cirrhosis: a prospective, multicenter study

Masanori Atsukawa^#¹, Akihito Tsubota^#², Chisa Kondo³, Kaori-Shioda Koyano³, Toru Ishikawa⁴, Hidenori Toyoda⁵, Koichi Takaguchi⁶, Tsunamasa Watanabe⁷, Kentaro Matsuura⁸, Chikara Ogawa⁹, Atsushi Hiraoka¹⁰, Hironao Okubo¹¹, Masakuni Tateyama¹², Haruki Uojima¹³, Akito Nozaki¹⁴, Makoto Chuma¹⁴, Keizo Kato¹⁵, Shigeru Mikami¹⁶, Joji Tani¹⁷, Asahiro Morishita¹⁷, Kazuhito Kawata¹⁸, Toshifumi Tada¹⁹, Yoshihiro Furuichi²⁰, Tomomi Okubo²¹, Tadamichi Kawano³, Taeang Arai³, Naoto Kawabe²², Naohiro Kawamura²³, Tadashi Ikegami²⁴, Makoto Nakamuta²⁵, Ryuta Shigefuku²⁶, Motoh Iwasa²⁶, Yasuhito Tanaka¹², Masaru Hatano²⁷, Katsuhiko Iwakiri³

Affiliations

¹ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Nippon Medical School, 1-1-5Bunkyo-Ku, SendagiTokyo, 113-8603, Japan. momogachi@yahoo.co.jp.
² Core Research Facilities for Basic Science, The Jikei University School of Medicine, Tokyo, Japan.
³ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Nippon Medical School, 1-1-5Bunkyo-Ku, SendagiTokyo, 113-8603, Japan.
⁴ Department of Hepatology, Saiseikai Niigata Hospital, Niigata, Japan.
⁵ Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Gifu, Japan.
⁶ Department of Hepatology, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa, Japan.
⁷ Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.
⁸ Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan.
⁹ Department of Gastroenterology and Hepatology, Takamatsu Red Cross Hospital, Takamatsu, Japan.
¹⁰ Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Ehime, Japan.
¹¹ Department of Gastroenterology, Juntendo Nerima University Hospital, Tokyo, Japan.
¹² Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
¹³ Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Kanagawa, Japan.
¹⁴ Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan.
¹⁵ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Shinmatusdo Central General Hospital, Matsudo, Japan.
¹⁶ Division of Gastroenterology, Department of Internal Medicine, Kikkoman General Hospital, Noda, Japan.
¹⁷ Department of Gastroenterology, Kagawa University Graduate School of Medicine, Kagawa, Japan.
¹⁸ Hepatology Division, Department of Internal Medicine II, Hamamatsu University School of Medicine, Hamamatsu, Japan.
¹⁹ Department of Internal Medicine, Japanese Red Cross Himeji Hospital, Hygo, Japan.
²⁰ Department of Clinical Laboratory and Endoscopy, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan.
²¹ Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Japan.
²² Department of Gastroenterology and Hepatology, Fujita Health University School of Medicine, Aichi, Japan.
²³ Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan.
²⁴ Division of Hepatology and Gastroenterology, Department of Internal Medicine, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan.
²⁵ National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
²⁶ Department of Gastroenterology and Hepatology, Mie University School of Medicine, Mie, Japan.
²⁷ Department of Advanced Medical Center for Heart Failure, The University of Tokyo Hospital, Tokyo, Japan.

^# Contributed equally.

PMID: 36477691
DOI: 10.1007/s12072-022-10456-y

Randomized Controlled Trial

Risk factors for portopulmonary hypertension in patients with cirrhosis: a prospective, multicenter study

Masanori Atsukawa et al. Hepatol Int. 2023 Feb.

. 2023 Feb;17(1):139-149.

doi: 10.1007/s12072-022-10456-y. Epub 2022 Dec 7.

Authors

Affiliations

¹ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Nippon Medical School, 1-1-5Bunkyo-Ku, SendagiTokyo, 113-8603, Japan. momogachi@yahoo.co.jp.
² Core Research Facilities for Basic Science, The Jikei University School of Medicine, Tokyo, Japan.
³ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Nippon Medical School, 1-1-5Bunkyo-Ku, SendagiTokyo, 113-8603, Japan.
⁴ Department of Hepatology, Saiseikai Niigata Hospital, Niigata, Japan.
⁵ Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Gifu, Japan.
⁶ Department of Hepatology, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa, Japan.
⁷ Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.
⁸ Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan.
⁹ Department of Gastroenterology and Hepatology, Takamatsu Red Cross Hospital, Takamatsu, Japan.
¹⁰ Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Ehime, Japan.
¹¹ Department of Gastroenterology, Juntendo Nerima University Hospital, Tokyo, Japan.
¹² Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
¹³ Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Kanagawa, Japan.
¹⁴ Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan.
¹⁵ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Shinmatusdo Central General Hospital, Matsudo, Japan.
¹⁶ Division of Gastroenterology, Department of Internal Medicine, Kikkoman General Hospital, Noda, Japan.
¹⁷ Department of Gastroenterology, Kagawa University Graduate School of Medicine, Kagawa, Japan.
¹⁸ Hepatology Division, Department of Internal Medicine II, Hamamatsu University School of Medicine, Hamamatsu, Japan.
¹⁹ Department of Internal Medicine, Japanese Red Cross Himeji Hospital, Hygo, Japan.
²⁰ Department of Clinical Laboratory and Endoscopy, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan.
²¹ Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Japan.
²² Department of Gastroenterology and Hepatology, Fujita Health University School of Medicine, Aichi, Japan.
²³ Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan.
²⁴ Division of Hepatology and Gastroenterology, Department of Internal Medicine, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan.
²⁵ National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
²⁶ Department of Gastroenterology and Hepatology, Mie University School of Medicine, Mie, Japan.
²⁷ Department of Advanced Medical Center for Heart Failure, The University of Tokyo Hospital, Tokyo, Japan.

^# Contributed equally.

PMID: 36477691
DOI: 10.1007/s12072-022-10456-y

Abstract

Background: Tricuspid regurgitation pressure gradient (TRPG) measurement by echocardiography is recommended as the most objective examination to detect portopulmonary hypertension (PoPH). This study aimed to identify factors associated with a high TRPG in patients with cirrhosis and develop a scoring model for identifying patients who are most likely to benefit from echocardiography investigations.

Results: A total of 486 patients who underwent echocardiography were randomly allocated to the derivation and validation sets at a ratio of 2:1. Of the patients, 51 (10.5%) had TRPG ≥ 35 mmHg. The median brain natriuretic peptide (BNP) was 39.5 pg/mL. Shortness of breath (SOB) was reported by 91 (18.7%) patients. In the derivation set, multivariate analysis identified female gender, shortness of breath, and BNP ≥ 48.9 pg/mL as independent factors for TRPG ≥ 35 mmHg. The risk score for predicting TRPG ≥ 35 mmHg was calculated as follows: - 3.596 + 1.250 × gender (female: 1, male: 0) + 1.093 × SOB (presence: 1, absence: 0) + 0.953 × BNP (≥ 48.9 pg/mL: 1, < 48.9 pg/mL: 0). The risk score yielded sensitivity of 66.7%, specificity of 75.3%, positive predictive value of 25.5%, negative predict value of 94.3%, and predictive accuracy of 74.4% for predicting TRPG ≥ 35 mmHg. These results were almost similar in the validation set, indicating the reproducibility and validity of the risk score.

Conclusions: This study clarified the characteristics of patients with suspected PoPH and developed a scoring model for identifying patients at high risk of PoPH, which may be used in selecting patients that may benefit from echocardiography.

Keywords: Brain natriuretic peptide; Echocardiography; Female; Liver cirrhosis; Portal hypertension; Portopulmonary hypertension; Pulmonary artery hypertension; Pulmonary hypertension; Shortness of breath; Tricuspid regurgitation pressure gradient.

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References

1. Salerno F, Gerbes A, Ginès P, et al. Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis. Gut. 2007;56(9):1310–1318
1. Hervé P, Lebrec D, Brenot F, et al. Pulmonary vascular disorders in portal hypertension. Eur Respir J. 1998;11(5):1153–1166 - DOI
1. Krowka MJ, Fallon MB, Kawut SM, et al. International liver transplant society practice guidelines: diagnosis and management of hepatopulmonary syndrome and portopulmonary hypertension. Transplantation. 2016;100(7):1440–1452 - DOI
1. Rodríguez-Roisin R, Krowka MJ, Hervé P, et al. ERS task force pulmonary-hepatic vascular disorders (PHD) scientific committee. Pulmonary-hepatic vascular disorders (PHD). Eur Respir J. 2004;24(5):861–880
1. Savale L, Watherald J, Sitbon O. Portopulmonary hypertension. Semin Respir Crit Care Med. 2017;38(5):651–661 - DOI

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Risk factors for portopulmonary hypertension in patients with cirrhosis: a prospective, multicenter study

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Risk factors for portopulmonary hypertension in patients with cirrhosis: a prospective, multicenter study

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