Pulmonary Dysfunction in Patients with Liver Cirrhosis

Pulmonary abnormalities and symptoms are common in patients with chronic liver disease and up to 70% of cirrhotic patients undergoing evaluation for liver transplantation complain of dyspnea. Pulmonary dysfunction has been seen in approximately one third of patients with chronic liver disease.
A variety of causes for pulmonary dysfunction in liver disease have been identified and include intrinsic cardiopulmonary disorders not specifically related to liver disease as well as unique problems associated with the presence of liver disease and/or portal hypertension.
Our study aimed to study the pattern and the extent  of pulmonary function affection in cirrhotic patients and its relation to the Child- Pugh classification and to Model For End Stage Liver Disease Score (MELD score).
This study was carried out on 90 subjects divided into three groups according to Child –Pugh score: 30 patients Child-Pugh A group, 30 patients Child-Pugh B group and 30 patients Child-Pugh C group. All patient included in this work have documented liver cirrhosis, their chest were radiologically free.
All patients were subjected to complete history taking and physical examination, abdominal ultrasonography, chest x ray, pulmonary function tests.
We found that 55.56% of the patients being studied complaining of dyspnea. The result obtained from the flow volume data revealed a decrease in all values of patient’s group in comparison to predicted value; this indicates the presence of a mild mixed obstructive and restrictive ventilatory pattern especially in advanced degree of Child-Pugh score. The pulmonary changes seen in cirrhotic patients were closely related to the degree of hepatic involvement as when comparing the pulmonary function test parameters, the FEV1 and FVC values were found to be lower in the Child–Pugh C group.
This study shows that pulmonary functions impairment in patients with liver cirrhosis is accentuated with presence of ascites; we found that of pulmonary function tests parameters FEV1 and FVC were significantly lower than the predicted value in patients with ascites compared to those without.
This study found a significant inverse relationship between FVC (as percent of predicted) and serum bilirubin concentration and a highly significant positive correlation between FVC and S. albumin in the studied patients.