Hepatopulmonary syndrome laboratory findings: Difference between revisions

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==Overview==
==Overview==
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of hepatopulmonary syndrome.
Atrial blood gas analysis (ABG) is used both for diagnosis and evaluating the severity (grade) of hepatopulmonary syndrome.


OR
A variety of laburatory tests might be used for the management and followup of patients with cirrhosis among them are,  [[Bilirubin|serum bilirubin]] levels, [[Transaminase|aminotransferase]] levels, [[alkaline phosphatase]], [[gamma-glutamyl transpeptidase]] , [[prothrombin time]]/[[Prothrombin time|INR]], complete blood count (CBC), electrolytes, blood urea nitrogen ([[Blood urea nitrogen|BUN]]) and [[creatinine]].  
 
Laboratory findings consistent with the diagnosis of hepatopulmonary syndrome include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
 
OR
 
[Test] is usually normal for patients with hepatopulmonary syndrome.
 
OR
 
Some patients with hepatopulmonary syndrome may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
 
OR
 
There are no diagnostic laboratory findings associated with hepatopulmonary syndrome.


==Laboratory Findings==
==Laboratory Findings==


Atrial blood gas analysis (ABG) is used both for diagnosis and evaluating the degree (severity) of the HPS as follows:
Atrial blood gas analysis (ABG) is used both for diagnosis and evaluating the degree (severity) of the HPS as follows:<ref name="pmid12427789">Schenk P, Fuhrmann V, Madl C, Funk G, Lehr S, Kandel O et al. (2002) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12427789 Hepatopulmonary syndrome: prevalence and predictive value of various cut offs for arterial oxygenation and their clinical consequences.] ''Gut'' 51 (6):853-9. [http://dx.doi.org/10.1136/gut.51.6.853 DOI:10.1136/gut.51.6.853] PMID: [https://pubmed.gov/12427789 12427789]</ref><ref name="pmid14708947">Lima BL, França AV, Pazin-Filho A, Araújo WM, Martinez JA, Maciel BC et al. (2004) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14708947 Frequency, clinical characteristics, and respiratory parameters of hepatopulmonary syndrome.] ''Mayo Clin Proc'' 79 (1):42-8. [http://dx.doi.org/10.4065/79.1.42 DOI:10.4065/79.1.42] PMID: [https://pubmed.gov/14708947 14708947]</ref>


* Alveolar-arterial oxygen gradient >/= 15 mmHg in room air : The most sensitive measurement of ABG for HPS diagnosis
* Alveolar-arterial oxygen gradient >/= 15 mmHg in room air : The most sensitive measurement of ABG for HPS diagnosis
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*  
*  


Common cirrhosis abnormal laboratory findings are as follows:<ref name="pmid22656328">{{cite journal |vauthors=Chalasani N, Younossi Z, Lavine JE, Diehl AM, Brunt EM, Cusi K, Charlton M, Sanyal AJ |title=The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology |journal=Gastroenterology |volume=142 |issue=7 |pages=1592–609 |year=2012 |pmid=22656328 |doi=10.1053/j.gastro.2012.04.001 |url=}}</ref><ref name="pmid22357834">{{cite journal |vauthors=Udell JA, Wang CS, Tinmouth J, FitzGerald JM, Ayas NT, Simel DL, Schulzer M, Mak E, Yoshida EM |title=Does this patient with liver disease have cirrhosis? |journal=JAMA |volume=307 |issue=8 |pages=832–42 |year=2012 |pmid=22357834 |doi=10.1001/jama.2012.186 |url=}}</ref><ref name="pmid27995906">{{cite journal |vauthors=Kwo PY, Cohen SM, Lim JK |title=ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries |journal=Am. J. Gastroenterol. |volume=112 |issue=1 |pages=18–35 |year=2017 |pmid=27995906 |doi=10.1038/ajg.2016.517 |url=}}</ref><ref name="pmid11853185">{{cite journal |vauthors=Cabrera-Abreu JC, Green A |title=Gamma-glutamyltransferase: value of its measurement in paediatrics |journal=Ann. Clin. Biochem. |volume=39 |issue=Pt 1 |pages=22–5 |year=2002 |pmid=11853185 |doi=10.1258/0004563021901685 |url=}}</ref><ref name="pmid2857631">{{cite journal |vauthors=Moussavian SN, Becker RC, Piepmeyer JL, Mezey E, Bozian RC |title=Serum gamma-glutamyl transpeptidase and chronic alcoholism. Influence of alcohol ingestion and liver disease |journal=Dig. Dis. Sci. |volume=30 |issue=3 |pages=211–4 |year=1985 |pmid=2857631 |doi= |url=}}</ref>


* Increased [[Bilirubin|serum bilirubin]] levels<ref name="pmid10498635">{{cite journal |vauthors=Krzeski P, Zych W, Kraszewska E, Milewski B, Butruk E, Habior A |title=Is serum bilirubin concentration the only valid prognostic marker in primary biliary cirrhosis? |journal=Hepatology |volume=30 |issue=4 |pages=865–9 |year=1999 |pmid=10498635 |doi=10.1002/hep.510300415 |url=}}</ref>
* Abnormal [[Transaminase|aminotransferase]] levels <ref name="pmid10781624">{{cite journal |vauthors=Pratt DS, Kaplan MM |title=Evaluation of abnormal liver-enzyme results in asymptomatic patients |journal=N. Engl. J. Med. |volume=342 |issue=17 |pages=1266–71 |year=2000 |pmid=10781624 |doi=10.1056/NEJM200004273421707 |url=}}</ref><ref name="pmid27995906" /><ref name="pmid20060831">{{cite journal |vauthors=Ruhl CE, Everhart JE |title=Trunk fat is associated with increased serum levels of alanine aminotransferase in the United States |journal=Gastroenterology |volume=138 |issue=4 |pages=1346–56, 1356.e1–3 |year=2010 |pmid=20060831 |pmc=2847039 |doi=10.1053/j.gastro.2009.12.053 |url=}}</ref><ref name="pmid12093239">{{cite journal |vauthors=Prati D, Taioli E, Zanella A, Della Torre E, Butelli S, Del Vecchio E, Vianello L, Zanuso F, Mozzi F, Milani S, Conte D, Colombo M, Sirchia G |title=Updated definitions of healthy ranges for serum alanine aminotransferase levels |journal=Ann. Intern. Med. |volume=137 |issue=1 |pages=1–10 |year=2002 |pmid=12093239 |doi= |url=}}</ref><ref name="pmid9581673">{{cite journal |vauthors=Piton A, Poynard T, Imbert-Bismut F, Khalil L, Delattre J, Pelissier E, Sansonetti N, Opolon P |title=Factors associated with serum alanine transaminase activity in healthy subjects: consequences for the definition of normal values, for selection of blood donors, and for patients with chronic hepatitis C. MULTIVIRC Group |journal=Hepatology |volume=27 |issue=5 |pages=1213–9 |year=1998 |pmid=9581673 |doi=10.1002/hep.510270505 |url=}}</ref><ref name="pmid12093245">{{cite journal |vauthors=Kaplan MM |title=Alanine aminotransferase levels: what's normal? |journal=Ann. Intern. Med. |volume=137 |issue=1 |pages=49–51 |year=2002 |pmid=12093245 |doi= |url=}}</ref><ref name="pmid15983331">{{cite journal |vauthors=Nannipieri M, Gonzales C, Baldi S, Posadas R, Williams K, Haffner SM, Stern MP, Ferrannini E |title=Liver enzymes, the metabolic syndrome, and incident diabetes: the Mexico City diabetes study |journal=Diabetes Care |volume=28 |issue=7 |pages=1757–62 |year=2005 |pmid=15983331 |doi= |url=}}</ref><ref name="pmid22764020">{{cite journal |vauthors=Liangpunsakul S, Chalasani N |title=What should we recommend to our patients with NAFLD regarding alcohol use? |journal=Am. J. Gastroenterol. |volume=107 |issue=7 |pages=976–8 |year=2012 |pmid=22764020 |pmc=3766378 |doi=10.1038/ajg.2012.20 |url=}}</ref><ref name="pmid520102">{{cite journal |vauthors=Cohen JA, Kaplan MM |title=The SGOT/SGPT ratio--an indicator of alcoholic liver disease |journal=Dig. Dis. Sci. |volume=24 |issue=11 |pages=835–8 |year=1979 |pmid=520102 |doi= |url=}}</ref><ref name="pmid18328931">{{cite journal |vauthors=Schuppan D, Afdhal NH |title=Liver cirrhosis |journal=Lancet |volume=371 |issue=9615 |pages=838–51 |year=2008 |pmid=18328931 |pmc=2271178 |doi=10.1016/S0140-6736(08)60383-9 |url=}}</ref><ref name="pmid19501929">{{cite journal |vauthors= |title=EASL Clinical Practice Guidelines: management of cholestatic liver diseases |journal=J. Hepatol. |volume=51 |issue=2 |pages=237–67 |year=2009 |pmid=19501929 |doi=10.1016/j.jhep.2009.04.009 |url=}}</ref>
* Elevated [[alkaline phosphatase]] 
* Elevated [[gamma-glutamyl transpeptidase]] 
* Prolonged [[prothrombin time]]/[[Prothrombin time|INR]]
* [[Thrombocytopenia]]
* [[Hyponatremia]] 


An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of hepatopulmonary syndrome.
<br />
 
OR
 
[Test] is usually normal among patients with hepatopulmonary syndrome.
 
OR
 
Laboratory findings consistent with the diagnosis of hepatopulmonary syndrome include:
*[Abnormal test 1]
*[Abnormal test 2]
*[Abnormal test 3]
 
OR
 
Some patients with hepatopulmonary syndrome may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].


==References==
==References==
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2]

Overview

Atrial blood gas analysis (ABG) is used both for diagnosis and evaluating the severity (grade) of hepatopulmonary syndrome.

A variety of laburatory tests might be used for the management and followup of patients with cirrhosis among them are, serum bilirubin levels, aminotransferase levels, alkaline phosphatase, gamma-glutamyl transpeptidase , prothrombin time/INR, complete blood count (CBC), electrolytes, blood urea nitrogen (BUN) and creatinine.  

Laboratory Findings

Atrial blood gas analysis (ABG) is used both for diagnosis and evaluating the degree (severity) of the HPS as follows:[1][2]

  • Alveolar-arterial oxygen gradient >/= 15 mmHg in room air : The most sensitive measurement of ABG for HPS diagnosis
  • Partial pressure of oxygen < 80 mmHg : generally present in sever HPS, late diagnostic finding
  • Degree of severity:
  • HPS can be classified in term of severity based on atrial blood gas analysis, as follows:
    • Mild: Alveolar-arterial oxygen gradient above, or equal to 15mmHg, partial pressure of oxygen  80mmHg.
    • Moderate: Alveolar-arterial oxygen gradient 15mmHg, partial pressure of oxygen  60 up to 80mmHg.
    • Severe: Alveolar-arterial oxygen gradient  15mmHg, partial pressure of oxygen  50 up to 60mmHg.
    • Very severe: Alveolar-arterial oxygen gradient 15mmHg, partial pressure of oxygen below 50 mmHg (< 300mmHg while the patient is breathing 100% oxygen).

Common cirrhosis abnormal laboratory findings are as follows:[3][4][5][6][7]


References

  1. ↑ Schenk P, Fuhrmann V, Madl C, Funk G, Lehr S, Kandel O et al. (2002) Hepatopulmonary syndrome: prevalence and predictive value of various cut offs for arterial oxygenation and their clinical consequences. Gut 51 (6):853-9. DOI:10.1136/gut.51.6.853 PMID: 12427789
  2. ↑ Lima BL, França AV, Pazin-Filho A, Araújo WM, Martinez JA, Maciel BC et al. (2004) Frequency, clinical characteristics, and respiratory parameters of hepatopulmonary syndrome. Mayo Clin Proc 79 (1):42-8. DOI:10.4065/79.1.42 PMID: 14708947
  3. ↑ Chalasani N, Younossi Z, Lavine JE, Diehl AM, Brunt EM, Cusi K, Charlton M, Sanyal AJ (2012). "The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology". Gastroenterology. 142 (7): 1592–609. doi:10.1053/j.gastro.2012.04.001. PMID 22656328.
  4. ↑ Udell JA, Wang CS, Tinmouth J, FitzGerald JM, Ayas NT, Simel DL, Schulzer M, Mak E, Yoshida EM (2012). "Does this patient with liver disease have cirrhosis?". JAMA. 307 (8): 832–42. doi:10.1001/jama.2012.186. PMID 22357834.
  5. ↑ 5.0 5.1 Kwo PY, Cohen SM, Lim JK (2017). "ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries". Am. J. Gastroenterol. 112 (1): 18–35. doi:10.1038/ajg.2016.517. PMID 27995906.
  6. ↑ Cabrera-Abreu JC, Green A (2002). "Gamma-glutamyltransferase: value of its measurement in paediatrics". Ann. Clin. Biochem. 39 (Pt 1): 22–5. doi:10.1258/0004563021901685. PMID 11853185.
  7. ↑ Moussavian SN, Becker RC, Piepmeyer JL, Mezey E, Bozian RC (1985). "Serum gamma-glutamyl transpeptidase and chronic alcoholism. Influence of alcohol ingestion and liver disease". Dig. Dis. Sci. 30 (3): 211–4. PMID 2857631.
  8. ↑ Krzeski P, Zych W, Kraszewska E, Milewski B, Butruk E, Habior A (1999). "Is serum bilirubin concentration the only valid prognostic marker in primary biliary cirrhosis?". Hepatology. 30 (4): 865–9. doi:10.1002/hep.510300415. PMID 10498635.
  9. ↑ Pratt DS, Kaplan MM (2000). "Evaluation of abnormal liver-enzyme results in asymptomatic patients". N. Engl. J. Med. 342 (17): 1266–71. doi:10.1056/NEJM200004273421707. PMID 10781624.
  10. ↑ Ruhl CE, Everhart JE (2010). "Trunk fat is associated with increased serum levels of alanine aminotransferase in the United States". Gastroenterology. 138 (4): 1346–56, 1356.e1–3. doi:10.1053/j.gastro.2009.12.053. PMC 2847039. PMID 20060831.
  11. ↑ Prati D, Taioli E, Zanella A, Della Torre E, Butelli S, Del Vecchio E, Vianello L, Zanuso F, Mozzi F, Milani S, Conte D, Colombo M, Sirchia G (2002). "Updated definitions of healthy ranges for serum alanine aminotransferase levels". Ann. Intern. Med. 137 (1): 1–10. PMID 12093239.
  12. ↑ Piton A, Poynard T, Imbert-Bismut F, Khalil L, Delattre J, Pelissier E, Sansonetti N, Opolon P (1998). "Factors associated with serum alanine transaminase activity in healthy subjects: consequences for the definition of normal values, for selection of blood donors, and for patients with chronic hepatitis C. MULTIVIRC Group". Hepatology. 27 (5): 1213–9. doi:10.1002/hep.510270505. PMID 9581673.
  13. ↑ Kaplan MM (2002). "Alanine aminotransferase levels: what's normal?". Ann. Intern. Med. 137 (1): 49–51. PMID 12093245.
  14. ↑ Nannipieri M, Gonzales C, Baldi S, Posadas R, Williams K, Haffner SM, Stern MP, Ferrannini E (2005). "Liver enzymes, the metabolic syndrome, and incident diabetes: the Mexico City diabetes study". Diabetes Care. 28 (7): 1757–62. PMID 15983331.
  15. ↑ Liangpunsakul S, Chalasani N (2012). "What should we recommend to our patients with NAFLD regarding alcohol use?". Am. J. Gastroenterol. 107 (7): 976–8. doi:10.1038/ajg.2012.20. PMC 3766378. PMID 22764020.
  16. ↑ Cohen JA, Kaplan MM (1979). "The SGOT/SGPT ratio--an indicator of alcoholic liver disease". Dig. Dis. Sci. 24 (11): 835–8. PMID 520102.
  17. ↑ Schuppan D, Afdhal NH (2008). "Liver cirrhosis". Lancet. 371 (9615): 838–51. doi:10.1016/S0140-6736(08)60383-9. PMC 2271178. PMID 18328931.
  18. ↑ "EASL Clinical Practice Guidelines: management of cholestatic liver diseases". J. Hepatol. 51 (2): 237–67. 2009. doi:10.1016/j.jhep.2009.04.009. PMID 19501929.

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