Rodríguez-Romero E, Suárez-Cuenca JA, Melchor-López A, Elizalde-Barrera CI, Dávila-Sosa D, Martínez-Hernández JE, Gómez-Cortés E, Pérez-Cabeza de Vaca R, Mondragón-Terán P, Jiménez-Saab NG

Language: Spanish
References: 9
Page: 248-253
PDF size: 292.39 Kb.

ABSTRACT

Background: Most patients with advanced liver disease have some lung complication, which worsens the prognosis of morbidity and mortality. The hepatopulmonary syndrome (HPS) is a common respiratory dysfunction in patients with chronic liver disease (CLD), which associates to intrapulmonary shunts and local nitric oxide deficiency, clinically manifested by hypoxemia and respiratory disorders. The participation of other mediators in regulating the airflow is not very clear. Alpha₁- antitrypsin (α₁AT) is a protein produced by the liver, and decreased serum levels of α₁AT or the expression of genetic variants results in airflow obstruction.
Objective: To evaluate the relation between serum levels α₁AT and the airflow dynamics in patients with CLD decompensated by HPS, as well as in their respective controls.
Material and methods: An observational, analytical cross sectional study included 42 patients aged 18 to 70 years old, with alcoholic CLD Child-Pugh score B (score 7-9) and C (score ›10), complicated by HPS, or controls lacking such complication. Patients were treated in second level medical units from the Federal District Health Services from November 2013 to March 2014. Patients with hepatic encephalopathy, risk exposure to lung injury, COPD diagnosis or limiting respiratory conditions were excluded. The HPS was diagnosed by testing orteodoxia plus additional suggestive symptoms. α₁AT serum levels were determined by nephelometry, while airflow was estimated by standard spirometric test.
Results: The study included 28 patients with HPS and 14 controls matched for age without HPS. The mean age was 57 years old, 23 of 42 patients were male. Mean serum level of α₁AT was 27.3 ng/mL. α₁AT levels showed an overall correlation r=0.27 (-0.04 to 0.5, p=0.09) with FEV₁ values showing statistical significance only in the group without HPS (r=0.52 [0.12 to 0.77], p=0.01) vs 0.25 (-0.08 to 0.53, p=0.13)in the group with HPS. The multinomial logistic regression analysis showed that age was an independent predictor of airflow obstruction (exp[B] 21.9, p=0.02) and a limitation in the forced vital capacity may predict airflow obstruction, specifically in patients with HPS (exp[B] 1.38, p=0.03).
Conclusions: Serum levels of α₁AT are related to the degree of airflow obstruction, particularly in patients with CLD free of HPS.

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