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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Predictive models and clinical manifestations of intrapulmonary vascular dilatation and hepatopulmonary syndrome in patients with cirrhosis: Prospective comparative study
Zhi-Peng Wu, Ying-Fei Wang, Feng-Wei Shi, Wen-Hui Cao, Jie Sun, Liu Yang, Fang-Ping Ding, Cai-Xia Hu, Wei-Wei Kang, Jing Han, Rong-Hui Yang, Qing-Kun Song, Jia-Wei Jin, Hong-Bo Shi, Ying-Min Ma
Zhi-Peng Wu, Ying-Fei Wang, Feng-Wei Shi, Wen-Hui Cao, Rong-Hui Yang, Hong-Bo Shi, Beijing Institute of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
Jie Sun, Department of Respiratory and Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
Liu Yang, Fang-Ping Ding, Department of Respiratory and Critical Care Medicine, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
Cai-Xia Hu, Hepatic Disease and Tumor Interventional Treatment Center, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
Wei-Wei Kang, Fourth Department of Liver Disease, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
Jing Han, Ultrasound and Functional Diagnosis Center, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
Qing-Kun Song, Division of Clinical Epidemiology and Evidence-Based Medicine, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
Jia-Wei Jin, Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100043, China
Ying-Min Ma, Beijing Institute of Hepatology, Department of Respiratory and Critical Care Medicine, Beijing Youan Hospital, Capital Medical University, Beijing 100069, Beijing, China
Co-first authors: Zhi-Peng Wu and Ying-Fei Wang.
Co-corresponding authors: Hong-Bo Shi and Ying-Min Ma.
Author contributions: Ma YM, Shi HB, Wu ZP, Wang YF, and Yang L contributed to the conceptualization of the study; Sun J, Shi FW, Cao WH, Hui CX, Kang WW, Han J, and Ding FP contributed to the data and blood sample collection; Wu ZP, Wang YF, Yang RH, and Song QK contributed to the formal analyses; Ding FP, Wang YF, Yang L, and Cao WH contributed to ELISA testing; Ma YM, Shi HB, and Yang RH contributed to the funding acquisition; Ma YM, Shi HB, and Jin JW contributed to the investigation; Wu ZP, Wang YF, and Song QK contributed to the methodology; Ma YM, Shi HB, and Song QK contributed to the supervision and validation; Wu ZP, Wang YF, and Ding FP contributed to the visualization; Wu ZP, Wang YF, and Shi HB contributed to writing the original draft; Ma YM, Shi HB, and Jin JW contributed to revising the manuscript; All authors read and approved the final manuscript.
Supported by the National Key Research and Development Program of China, No. 2022YFC2305002; Beijing Natural Science Foundation, No. 7232079; Middle-aged and Young Talent Incubation Programs (Clinical Research) of Beijing Youan Hospital, No. BJYAYY-YN2022-12, No. BJYAYY-YN2022-13, and No. BJYAYY-YN2022-01; and the China Postdoctoral Science Foundation, No. 2023M732410 and No. 2024T170595.
Institutional review board statement: This study was reviewed and approved by the Ethical Committee of Beijing Youan Hospital (No. LL-2022-141-K).
Clinical trial registration statement: This study is registered at ClinicalTrials.gov under registration identification number NCT05932927.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment, and patient information was anonymized.
Conflict-of-interest statement: Ma YM has received research funding from Beijing Natural Science Foundation, No. 7232079.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Ying-Min Ma, MD, Chief Physician, Full Professor, Beijing Institute of Hepatology, Department of Respiratory and Critical Care Medicine, Beijing Youan Hospital, Capital Medical University, No. 8 Xi Tou Tiao, Youanmenwai Street, Fengtai District, Beijing 100069, China.
ma.yingmin@163.com
Received: February 12, 2025
Revised: March 13, 2025
Accepted: March 26, 2025
Published online: April 21, 2025
Processing time: 65 Days and 0.2 Hours
BACKGROUND
Patients with cirrhosis with hepatopulmonary syndrome (HPS) have a poorer prognosis. The disease has a subtle onset, symptoms are easily masked, clinical attention is insufficient, and misdiagnosis rates are high.
AIM
To compare the clinical characteristics of patients with cirrhosis, cirrhosis combined with intrapulmonary vascular dilatation (IPVD), and HPS, and to establish predictive models for IPVD and HPS.
METHODS
Patients with cirrhosis were prospectively screened at a liver-specialized university teaching hospital. Clinical information and blood samples were collected, and biomarker levels in blood samples were measured. Patients with cirrhosis were divided into three groups: Those with pure cirrhosis, those with combined IPVD, and those with HPS based on contrast-enhanced transthoracic echocardiography results and the pulmonary alveolar-arterial oxygen gradient values. Univariate logistic regression and Least Absolute Shrinkage and Selection Operator (LASSO) regression methods were utilized to identify risk factors for IPVD and HPS, and nomograms were constructed to predict IPVD and HPS.
RESULTS
A total of 320 patients were analyzed, with 101 diagnosed with IPVD, of whom 54 were diagnosed with HPS. There were statistically significant differences in clinical parameters among these three groups of patients. Among the tested biomarkers, sphingosine 1 phosphate, angiopoietin-2, and platelet-derived growth factor BB were significantly associated with IPVD and HPS in patients with cirrhosis. Following LASSO logistic regression screening, prediction models for IPVD and HPS were established. The area under the receiver operating characteristic curve for IPVD prediction was 0.792 (95% confidence interval [CI]: 0.737-0.847), and for HPS prediction was 0.891 (95%CI: 0.848-0.934).
CONCLUSION
This study systematically compared the clinical characteristics of patients with cirrhosis, IPVD, and HPS, and constructed predictive models for IPVD and HPS based on clinical parameters and laboratory indicators. These models showed good predictive value for IPVD and HPS in patients with cirrhosis. They can assist clinicians in the early prognosis assessment of patients with cirrhosis, ultimately benefiting the patients.
Core Tip: This study included 320 patients with liver cirrhosis, among whom 101 were diagnosed with intrapulmonary vascular dilatation (IPVD), and of these, 54 were diagnosed with hepatopulmonary syndrome (HPS). Nine potential biomarkers possibly related to HPS were tested, and the clinical parameters and biomarker levels of three patient groups were compared. Predictive models for IPVD and HPS were built respectively based on patients’ clinical information and three biomarkers: sphingosine 1 phosphate, angiopoietin-2, and platelet-derived growth factor BB.
