Role of Beta-Blockers in Prevention of Hepatopulmonary Syndrome in Chronic Liver Disease: An Observation

Abstract

Aim: Study was initiated to study the presence of hepatopulmonary syndrome (HPS) in chronic liver disease patients, and role
of beta-blockers in its occurrence. Methods: Patients admitted in Dept. of Medicine and patients attending the Medicine OPD
were examined and investigated for presence of HPS irrespective of its typical clinical features as explained in the literature.
Patients having ascites or pleural effusion were managed by means of paracentesis and pleural tap first and then included
in the study. Patients having any other primary pulmonary disease like bronchial asthma or chronic obstructive pulmonary
disease were excluded from the study. Arterial blood gas analysis and contrast-enhanced echocardiography was done to confirm
presence of arterial hypoxemia and pulmonary shunt, the diagnostic criteria. Results: During 1 year study, total 125 patients
were enrolled in the study after appropriate selection criteria. Twenty-eight out of 125 patients were not taking propranolol.
Propranolol is contraindicated in these patients for one or two reasons. Four out of these 28 patients developed HPS. One out
of 97 patients who were on propranolol developed HPS. Total 5 patients were confirmed having HPS. The Fisher’s exact test
statistic value is 0.008887. The result is significant at p < 0.01. Conclusion: Patients of cirrhosis with portal hypertension on
treatment with propranolol were having significantly lower chances of development of HPS then those without propranolol.
Propranolol may have preventive role for development of HPS.