Open Access Highly Accessed Research article

Hepatopulmonary syndrome in patients with chronic liver disease: role of pulse oximetry

Peter Deibert1*, Hans-Peter Allgaier4, Stefanie Loesch2, Claudia Müller5, Manfred Olschewski3, Hinrich Hamm6, Klaus-Peter Maier5 and Hubert Erich Blum2

Author Affiliations

1 Department of Medicine VII, University Freiburg, Germany

2 Department of Medicine II, University Freiburg, , Germany

3 Department of Medical Biometry, University Freiburg, , Germany

4 Helios Hospital, Department of Internal Medicine, Titisee-Neustadt, Germany

5 Liver Center, City Hospital Esslingen, Germany

6 Asklepios Klinik, Dept. of Internal Medicine and Lung Clinic, Westerland, Germany

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BMC Gastroenterology 2006, 6:15  doi:10.1186/1471-230X-6-15

Published: 25 April 2006



Hepatopulmonary syndrome (HPS) is a rare complication of liver diseases of different etiologies and may indicate a poor prognosis. Therefore, a simple non-invasive screening method to detect HPS would be highly desirable. In this study pulse oximetry was evaluated to identify patients with HPS.


In 316 consecutive patients with liver cirrhosis (n = 245), chronic hepatitis (n = 69) or non-cirrhotic portal hypertension (n = 2) arterial oxygen saturation (SaO2) was determined using a pulse oximeter. In patients with SaO2 ≤92% in supine position and/or a decrease of ≥4% after change from supine to upright position further diagnostic procedures were performed, including contrast-enhanced echocardiography and perfusion lung scan.


Seventeen patients (5.4%) had a pathological SaO2. Four patients (1.3%) had HPS. HPS patients had a significant lower mean SaO2 in supine (89.7%, SD 5.4 vs. 96.0%, SD 2.3; p = 0.003) and upright position (84.3%, SD 5.0 vs. 96.0%, SD 2.4; p = 0.001) and had a lower mean PaO2 (56.2 mm Hg, SD 15.2 vs. 71.2 mm Hg, SD 20.2; p = 0.02) as compared to patients without HPS. The mean ΔSaO2 (difference between supine and upright position) was 5.50 (SD 7) in HPS patients compared to non-HPS patients who showed no change (p = 0.001). There was a strong correlation between shunt volume and the SaO2 values (R = -0.94).


Arterial SaO2 determination in supine and upright position is a useful non-invasive screening test for HPS and correlates well with the intrapulmonary shunt volume.