Prevalence and Predictors of Hepatopulmonary Syndrome in Patients with Decompensated Chronic Liver Disease in Northern India

Introduction: Hepatopulmonary syndrome (HPS) is a potentially serious pulmonary manifestation of chronic liver disease (CLD), characterized by intrapulmonary vascular dilatations leading to hypoxemia. This study aimed to determine the prevalence and determinants of HPS in patients with decompensated CLD. Methods: This observational cross-sectional study was conducted at Swami Rama Himalayan University, Dehradun, India, between July 2023 and August 2024. Ninety-two patients with decompensated CLD were evaluated for HPS. HPS was diagnosed using the European Respiratory Society Task Force criteria. Results: Among 92 patients with decompensated CLD, 10 (10.9%) were diagnosed with HPS. Of these, 6 (60%) had moderate HPS, 3 (30%) had mild HPS, and 1 (10%) had severe HPS. Pulmonary hypertension was identified in 5 (5.4%) patients. HPS was significantly associated with hematemesis, orthodeoxia, Model for End-Stage Liver Disease (MELD) score, and Maddrey’s Discriminant Function (MDF) score (p < 0.05 for all). On multivariate analysis, orthodeoxia (odds ratio [OR]: 50.0, p = 0.011) and hematemesis (OR: 50.0, p = 0.002) were independently associated with HPS. Discussion: HPS is a relatively common yet under-recognized condition in patients with decompensated CLD. Although several clinical and severity markers were associated with HPS, only orthodeoxia and hematemesis emerged as independent determinants, suggesting their potential role as practical screening indicators in routine clinical practice. Conclusion: HPS is a clinically important complication of decompensated CLD. Orthodeoxia and hematemesis independently predict its presence. Routine screening for HPS in patients with CLD may facilitate early diagnosis, optimize management, and support timely referral for liver transplantation when appropriate.