Role of Pulse Oximetry in Detecting Mild to Moderate Hepatopulmonary Syndrome in Children

HamidReza Kianifar, Eftekhar Mahmoodi, SeyedAli Jafari, Habib Jafari, Farzaneh Fazeli, Pardis Shojaee, HabibOllah Esmaily, Hasan Karami


Background :Hepatopulmonary syndrome (HPS) refers to arterial hypoxemia caused by pulmonary vasodilation, which is a consequence of portal hypertension. HPS is associated with increased morbidity and mortality; thus, it is important to diagnose this entity as soon as possible for treatment to be administered.

Materials and Methods: In a cross-sectional study, 40 children (6 months to 14 years old) with chronic liver disease were enrolled. In all patients, measurements of Oxygen saturation (SaO2) were performed with a pulse oximeter in the supine position (SPO2) and then in the upright position (ΔSPO2). Children were divided into three groups: i) those with both SPO2›96% and ΔSPO2›4%; ii) children with either SPO2›96% or ΔSPO2› 4%; and iii) those with neither of these signs. Then, contrast-enhanced echocardiography (CEE) and arterial blood gas (ABG) were performed. Finally, the prevalence of mild to moderate HPS was calculated in the three groups.

Results: There were 30 patients who had neither of the two signs, of which 9 had HPS. Ten patients had one of the two signs, in whom 4 had HPS. None of the patients had both signs. The sensitivity of the pulse oximetry was 30%, specificity was 77%, positive predictive value was 38% and negative predictive value was 70%.

Conclusion: There is a significant prevalence of HPS in cirrhotic patients which effects prognosis. Based on our study results, we have determined that pulse oximetry could not be a reliable screening procedure in mild to moderate HPS. It is recommended to use gold standard tests (echocardiography and arterial blood gasometry) for the screening and diagnosis of HPS in children.


Hepatopulmonary Syndrome; Intrapulmonary shunt; Contrast echocardiography; Arterial oxygen saturation; Pulse oximetry

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