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

Abstract

Abstract Background Measurement of the tricuspid regurgitation pressure gradient (TRPG) by echocardiography is recommended as the most objective examination for the detection of portopulmonary hypertension (PoPH). This prospective study aimed to identify factors associated with a high TRPG in patients with cirrhosis and develop a screening method for identifying patients most likely to benefit from investigation with echocardiography.Results Four hundreds and eighty-six patients with cirrhosis underwent Doppler echocardiography, and were analyzed in the present study. Of the 486 patients, 51 (10.5%) had TRPG ≥35 mmHg. The median BNP was 39.5 (range, 3.3–712.0) pg/mL. Ninety-one (18.7%) patients reported shortness of breath. Multivariate analysis identified female, shortness of breath, and BNP ≥49 pg/mL as independent factors for TRPG ≥35 mmHg. The risk score for predicting TRPG ≥35 mmHg was calculated: risk score = −3.230 + 0.622 × gender (female: 1, male: 0) + 1.403 × shortness of breath (presence: 1, absence: 0) + 0.726 × BNP (≥ 49pg/mL: 1, <49 pg/mL: 0). An optimal cut-off risk score for predicting TRPG ≥35 mmHg was −1.882 (AUC, 0.731; sensitivity, 68.6%; specificity, 70.6%). The prevalence of TRPG ≥35 mmHg in patients with a risk score ≥−1.882 (21.5%) was significantly higher than that in patients with a risk score <−1.882 (5.0%) (p = 7.02 × 10−8).Conclusions We clarified the characteristics of patients with suspected PoPH, and developed a scoring model for identifying patients at high risk of PoPH, which may have utility in selecting patients with cirrhosis that may benefit from echocardiography.