Clinical risk factors for portopulmonary hypertension

Steven M. Kawut, Michael J. Krowka, James F. Trotter, Kari E. Roberts, Raymond L. Benza, David B. Badesch, Darren B. Taichman, Evelyn M. Horn, Steven Zacks, Neil Kaplowitz, Robert S. Brown, Michael B. Fallon

Research output: Contribution to journalArticle

154 Citations (Scopus)

Abstract

Portopulmonary hypertension affects up to 6% of patients with advanced liver disease, but the predictors and biologic mechanism for the development of this complication are unknown. We sought to determine the clinical risk factors for portopulmonary hypertension in patients with advanced liver disease. We performed a multicenter case-control study nested within a prospective cohort of patients with portal hypertension recruited from tertiary care centers. Cases had a mean pulmonary artery pressure > 25 mm Hg, pulmonary vascular resistance > 240 dynes·second·cm-5, and pulmonary capillary wedge pressure ≤ 15 mm Hg. Controls had a right ventricular systolic pressure < 40 mm Hg (if estimable) and normal right-sided cardiac morphology by transthoracic echocardiography. The study sample included 34 cases and 141 controls. Female sex was associated with a higher risk of portopulmonary hypertension than male sex (adjusted odds ratio = 2.90, 95% confidence interval 1.20-7.01, P = 0.018). Autoimmune hepatitis was associated with an increased risk (adjusted odds ratio = 4.02, 95% confidence interval 1.14-14.23, P = 0.031), and hepatitis C infection was associated with a decreased risk (adjusted odds ratio = 0.24, 95% confidence interval 0.09-0.65, P = 0.005) of portopulmonary hypertension. The severity of liver disease was not related to the risk of portopulmonary hypertension. Conclusion: Female sex and autoimmune hepatitis were associated with an increased risk of portopulmonary hypertension, whereas hepatitis C infection was associated with a decreased risk in patients widi advanced hver disease. Hormonal and immunologic factors may therefore be integral to the development of portopulmonary hypertension.

Original languageEnglish (US)
Pages (from-to)196-203
Number of pages8
JournalHepatology
Volume48
Issue number1
DOIs
StatePublished - Jul 1 2008
Externally publishedYes

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Hypertension
Liver Diseases
Autoimmune Hepatitis
Odds Ratio
Confidence Intervals
Hepatitis C
Pulmonary Wedge Pressure
Immunologic Factors
Portal Hypertension
Ventricular Pressure
Infection
Tertiary Care Centers
Vascular Resistance
Pulmonary Artery
Echocardiography
Case-Control Studies
Blood Pressure
Pressure

ASJC Scopus subject areas

  • Hepatology

Cite this

Kawut, S. M., Krowka, M. J., Trotter, J. F., Roberts, K. E., Benza, R. L., Badesch, D. B., ... Fallon, M. B. (2008). Clinical risk factors for portopulmonary hypertension. Hepatology, 48(1), 196-203. https://doi.org/10.1002/hep.22275

Clinical risk factors for portopulmonary hypertension. / Kawut, Steven M.; Krowka, Michael J.; Trotter, James F.; Roberts, Kari E.; Benza, Raymond L.; Badesch, David B.; Taichman, Darren B.; Horn, Evelyn M.; Zacks, Steven; Kaplowitz, Neil; Brown, Robert S.; Fallon, Michael B.

In: Hepatology, Vol. 48, No. 1, 01.07.2008, p. 196-203.

Research output: Contribution to journalArticle

Kawut, SM, Krowka, MJ, Trotter, JF, Roberts, KE, Benza, RL, Badesch, DB, Taichman, DB, Horn, EM, Zacks, S, Kaplowitz, N, Brown, RS & Fallon, MB 2008, 'Clinical risk factors for portopulmonary hypertension', Hepatology, vol. 48, no. 1, pp. 196-203. https://doi.org/10.1002/hep.22275
Kawut SM, Krowka MJ, Trotter JF, Roberts KE, Benza RL, Badesch DB et al. Clinical risk factors for portopulmonary hypertension. Hepatology. 2008 Jul 1;48(1):196-203. https://doi.org/10.1002/hep.22275
Kawut, Steven M. ; Krowka, Michael J. ; Trotter, James F. ; Roberts, Kari E. ; Benza, Raymond L. ; Badesch, David B. ; Taichman, Darren B. ; Horn, Evelyn M. ; Zacks, Steven ; Kaplowitz, Neil ; Brown, Robert S. ; Fallon, Michael B. / Clinical risk factors for portopulmonary hypertension. In: Hepatology. 2008 ; Vol. 48, No. 1. pp. 196-203.
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abstract = "Portopulmonary hypertension affects up to 6{\%} of patients with advanced liver disease, but the predictors and biologic mechanism for the development of this complication are unknown. We sought to determine the clinical risk factors for portopulmonary hypertension in patients with advanced liver disease. We performed a multicenter case-control study nested within a prospective cohort of patients with portal hypertension recruited from tertiary care centers. Cases had a mean pulmonary artery pressure > 25 mm Hg, pulmonary vascular resistance > 240 dynes·second·cm-5, and pulmonary capillary wedge pressure ≤ 15 mm Hg. Controls had a right ventricular systolic pressure < 40 mm Hg (if estimable) and normal right-sided cardiac morphology by transthoracic echocardiography. The study sample included 34 cases and 141 controls. Female sex was associated with a higher risk of portopulmonary hypertension than male sex (adjusted odds ratio = 2.90, 95{\%} confidence interval 1.20-7.01, P = 0.018). Autoimmune hepatitis was associated with an increased risk (adjusted odds ratio = 4.02, 95{\%} confidence interval 1.14-14.23, P = 0.031), and hepatitis C infection was associated with a decreased risk (adjusted odds ratio = 0.24, 95{\%} confidence interval 0.09-0.65, P = 0.005) of portopulmonary hypertension. The severity of liver disease was not related to the risk of portopulmonary hypertension. Conclusion: Female sex and autoimmune hepatitis were associated with an increased risk of portopulmonary hypertension, whereas hepatitis C infection was associated with a decreased risk in patients widi advanced hver disease. Hormonal and immunologic factors may therefore be integral to the development of portopulmonary hypertension.",
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AU - Badesch, David B.

AU - Taichman, Darren B.

AU - Horn, Evelyn M.

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N2 - Portopulmonary hypertension affects up to 6% of patients with advanced liver disease, but the predictors and biologic mechanism for the development of this complication are unknown. We sought to determine the clinical risk factors for portopulmonary hypertension in patients with advanced liver disease. We performed a multicenter case-control study nested within a prospective cohort of patients with portal hypertension recruited from tertiary care centers. Cases had a mean pulmonary artery pressure > 25 mm Hg, pulmonary vascular resistance > 240 dynes·second·cm-5, and pulmonary capillary wedge pressure ≤ 15 mm Hg. Controls had a right ventricular systolic pressure < 40 mm Hg (if estimable) and normal right-sided cardiac morphology by transthoracic echocardiography. The study sample included 34 cases and 141 controls. Female sex was associated with a higher risk of portopulmonary hypertension than male sex (adjusted odds ratio = 2.90, 95% confidence interval 1.20-7.01, P = 0.018). Autoimmune hepatitis was associated with an increased risk (adjusted odds ratio = 4.02, 95% confidence interval 1.14-14.23, P = 0.031), and hepatitis C infection was associated with a decreased risk (adjusted odds ratio = 0.24, 95% confidence interval 0.09-0.65, P = 0.005) of portopulmonary hypertension. The severity of liver disease was not related to the risk of portopulmonary hypertension. Conclusion: Female sex and autoimmune hepatitis were associated with an increased risk of portopulmonary hypertension, whereas hepatitis C infection was associated with a decreased risk in patients widi advanced hver disease. Hormonal and immunologic factors may therefore be integral to the development of portopulmonary hypertension.

AB - Portopulmonary hypertension affects up to 6% of patients with advanced liver disease, but the predictors and biologic mechanism for the development of this complication are unknown. We sought to determine the clinical risk factors for portopulmonary hypertension in patients with advanced liver disease. We performed a multicenter case-control study nested within a prospective cohort of patients with portal hypertension recruited from tertiary care centers. Cases had a mean pulmonary artery pressure > 25 mm Hg, pulmonary vascular resistance > 240 dynes·second·cm-5, and pulmonary capillary wedge pressure ≤ 15 mm Hg. Controls had a right ventricular systolic pressure < 40 mm Hg (if estimable) and normal right-sided cardiac morphology by transthoracic echocardiography. The study sample included 34 cases and 141 controls. Female sex was associated with a higher risk of portopulmonary hypertension than male sex (adjusted odds ratio = 2.90, 95% confidence interval 1.20-7.01, P = 0.018). Autoimmune hepatitis was associated with an increased risk (adjusted odds ratio = 4.02, 95% confidence interval 1.14-14.23, P = 0.031), and hepatitis C infection was associated with a decreased risk (adjusted odds ratio = 0.24, 95% confidence interval 0.09-0.65, P = 0.005) of portopulmonary hypertension. The severity of liver disease was not related to the risk of portopulmonary hypertension. Conclusion: Female sex and autoimmune hepatitis were associated with an increased risk of portopulmonary hypertension, whereas hepatitis C infection was associated with a decreased risk in patients widi advanced hver disease. Hormonal and immunologic factors may therefore be integral to the development of portopulmonary hypertension.

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