Assessment of lung function and functional capacity in patients with liver cirrhosis

Abstract

Background: Various changes can be detected by pulmonary function tests at patients diagnosed with chronic hepatic diseases. These changes characterize the “hepatopulmonary syndrome” result in hypoxemia and affect one-third of all patients diagnosed with cirrhosis.Hepatopulmonary syndrome is defined by liver disease, intrapulmonary vasodilatation at the capillary and pre-capillary levels, and impaired arterial oxygenation. The aim of this study is to assess and compare the pulmonary function and physical capacity in patients with liver cirrhosis according to the Child-Pugh score and to correlate these variables within each group. Methods: Into the study were enrolled 40 patients with liver cirrhosis. Spirometry, hemoglobin levels, dyspnea by BORG scale, exercise capacity by 6-min walking test (6MWT), blood gas analysis were evaluated. Blood gases were measured in supine and sitting positions. Results: The patients were classified into three groups, according to cirrhotic severity, using Child’sPugh classification (A - 7 patients; B - 24 patients; C - 9 patients). There were significant differences (p <0.01, ANOVA) in FEV1 between 3 groups: there was observed a decrease of pulmonary function with progression of cirrhosis from 107 ± 13.1% in group Child’s-Pugh A to 89 ± 17.4% in group Child’s-Pugh C. Also there was detected a diminution of Pa02 in supine and sitting positions with progression of cirrhosis. The longest 6-min walking distance (6MWD) was 435 ± 17.8 m by group A, then group B (354.6 ± 43.4 m), and group C (310 ± 63.6 m). There was a strong negative correlation between 6MWD and Child-Pugh classification (r = -0.55, p< 0.01). Conclusion: 6MWT is a useful tool for assessing physical function in chronic liver disease patients. The progress of liver disease contributes to the onset of several complications which together appear to contribute to the reduction of pulmonary function and functional capacity of patients.