Hepatopulmonary syndrome is related to the development of acute-on-chronic liver failure and poor prognosis in cirrhotic patients

Seul Ki Han, Moon Young Kim, Seong Hee Kang, Ki Tae Suk, Soon Koo Baik

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Background and aims: Long-term prospective data on hepatopulmonary syndrome (HPS) from a large number of patients, especially in Asian patients, are lacking. We evaluated the long-term prognosis of HPS and the development of acute-on-chronic liver failure (ACLF), and related factors. Methods: A total of 142 patients with cirrhosis who underwent saline-agitated contrast echocardiography for the diagnosis of HPS were enrolled and observed prospectively from 2014 to 2019. Results: A total of 59 patients (41%) were diagnosed with HPS (24 grade 1, 23 grade 2, 12 grade 3). Thirty-eight and 37 patients died in the HPS and non-HPS groups, respectively (p < 0.01). The 5-year survival rate was 47% in the HPS group and 62% in the non-HPS group. In the Cox proportional hazards model, HPS and Model for End-stage Liver Disease (MELD) score ≥ 18, and Child–Turcotte–Pugh (CTP) class B/C were significant risk factors for mortality after adjusting for other risk factors (HPS hazard ratio [HR] = 1.9, p = 0.01; MELD score ≥ 18 HR = 2.3, p < 0.01; CTP class B/C HR = 2.9, p < 0.01). Compared to that in non-HPS group, the HPS group had a significantly higher incidence of ACLF during follow-up (p < 0.01) and more frequently presented with lung involvement of ACLF (p = 0.03). Conclusions: In the long-term follow-up cohort, patients with HPS showed poorer prognosis than that of patients without HPS. HPS was a risk factor for ACLF development independent of hepatic dysfunction, and lung involvement was significantly common than without ACLF.

Original languageEnglish
Pages (from-to)1207-1214
Number of pages8
JournalHepatology International
Issue number5
Publication statusPublished - 2021 Oct

Bibliographical note

Funding Information:
This study was supported by the Research Supporting Program of The Korean Association for the Study of the Liver and the Korean Liver Foundation (KASLKLF2017-04).

Funding Information:
The authors acknowledge the assistance of the Regeneration Medicine Research Center and Mitohormesis Research Center of Yonsei University Wonju College of Medicine, as well as the study participants.

Publisher Copyright:
© 2021, Asian Pacific Association for the Study of the Liver.

All Science Journal Classification (ASJC) codes

  • Hepatology


Dive into the research topics of 'Hepatopulmonary syndrome is related to the development of acute-on-chronic liver failure and poor prognosis in cirrhotic patients'. Together they form a unique fingerprint.

Cite this