Predictive models and clinical manifestations of intrapulmonary vascular dilatation and hepatopulmonary syndrome in patients with cirrhosis: Prospective comparative study

doi:10.3748/wjg.v31.i15.105720

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World Journal of Gastroenterology

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Prospective Study

World J Gastroenterol. Apr 21, 2025; 31(15): 105720
Published online Apr 21, 2025. doi: 10.3748/wjg.v31.i15.105720

Table 1 Baseline characteristics and clinical data after hospitalization of patients with cirrhosis with and without intrapulmonary vascular dilatation, n (%)

Variables	Total (n = 320)	Without IPVD (n = 219)	With IPVD (n = 101)	P value
Demographic data
Sex, male	246 (77)	178 (81)	68 (67)	0.006
Age, years	58 (52-65)	59 (53-66)	56.00 (49-62)	0.001
Weight, kg	69 (60-77)	70 (61-77)	65 (56-77)	0.024
Height, m	1.70 (1.64-1.74)	1.70 (1.65-1.75)	1.68 (1.60-1.73)	0.052
BMI, kg/m²	24.03 (21.58-26.64)	24.47 (22.11-26.91)	23.24 (20.76-26.20)	0.046
Smoke	129 (40)	90 (41)	39 (39)	0.65
Drink	125 (39)	86 (39)	39 (39)	0.89
Cause¹
Alcoholic liver disease	65 (20)	43 (20)	22 (22)	0.66
Hepatitis B	189 (59)	142 (65)	47 (47)	0.002
Hepatitis C	44 (14)	31 (14)	13 (13)	0.76
NAFLD	5 (1.6)	3 (1.4)	2 (2.0)	0.65
Autoimmune hepatitis	26 (8.1)	12 (5.5)	14 (14)	0.011
Other	17 (5.3)	8 (3.7)	9 (8.9)	0.051
Co-morbidities
Hypertension	93 (29)	77 (35)	16 (16)	< 0.001
Diabetes	91 (28)	73 (33)	18 (18)	0.004
Heart failure	25 (7.8)	18 (8.2)	7 (6.9)	0.69
Kidney failure	60 (19)	41 (19)	19 (19)	0.98
Liver cancer	193 (60)	143 (65)	50 (50)	0.007
Esophageal varices	201 (63)	137 (63)	64 (63)	0.97
Bleeding	89 (28)	59 (27)	30 (30)	0.61
Ascites	207 (65)	130 (59)	77 (76)	0.003
Hepatic encephalopathy	94 (29)	56 (26)	38 (38)	0.028
Clubbing of the fingers	3 (0.9)	2 (0.9)	1 (1.0)	0.99
Palmar erythema	61 (19)	35 (16)	26 (26)	0.039
Spider angioma	8 (2.5)	3 (1.4)	5 (5.0)	0.11
Disease severity
MELD score	11.1 (5.9-17.8)	8.9 (5.5-14.3)	15.4 (10.0-25.8)	< 0.001
Child-Pugh classification				< 0.001
I	113 (35)	99 (45)	14 (14)
II	147 (46)	91 (42)	56 (55)
III	60 (19)	29 (13)	31 (31)
Decompensated stage	238 (74)	151 (69)	87 (86)	0.001
Arterial blood gas
PH	7.44 (7.42-7.46)	7.43 (7.41-7.45)	7.45 (7.42-7.47)	< 0.001
P(A-a)O₂, mmHg	16.7 (8.0-26.6)	14.4 (7.8-24.7)	23.6 (8.3-31.2)	0.014
PaO₂, mmHg	94.5 (84.6-105.1)	95.8 (85.6-105.9)	92.0 (81.5-102.5)	0.062
PaCO₂, mmHg	33.2 (29.9-36.9)	33.7 (30.7-37.3)	32.0 (28.7-35.4)	< 0.001
SpO₂, %	97.6 (96.8-98.3)	97.6 (96.9-98.3)	97.5 (96.6-98.2)	0.25
Laboratory parameters
CRP, mg/L	7.27 (2.26-17.74)	5.70 (2.25-19.10)	8.73 (2.30-15.97)	0.92
PCT, ng/mL	0.11 (0.05-0.38)	0.10 (0.05-0.28)	0.11 (0.07-0.56)	0.063
WBC count, × 10⁹/L	4.13 (2.91-6.15)	4.35 (3.16-6.42)	3.73 (2.58-5.02)	0.015
HGB, g/L	115 (95-131)	120 (99-135)	104 (84-117)	< 0.001
Platelet count, × 10⁹/L	80 (55-125)	86 (63-133)	61 (41-93)	< 0.001
Neutrophil count, × 10⁹/L	2.55 (1.67-4.34)	2.72 (1.82-4.57)	2.20 (1.42-3.81)	0.032
Lymphocyte count, × 10⁹/L	0.84 (0.53-1.25)	0.90 (0.57-1.31)	0.68 (0.47-0.99)	0.002
NLR	2.97 (1.83-6.03)	2.72 (1.84-6.03)	3.31 (1.78-5.91)	0.41
PLR	93.7 (67.2-148.7)	95.9 (69.1-156.7)	88.0 (59.1-129.4)	0.074
LCR	0.11 (0.04-0.34)	0.11 (0.04-0.41)	0.11 (0.04-0.30)	0.62
SII	248 (132-509)	261 (145-534)	200 (93-454)	0.020
CAR	0.20 (0.07-0.58)	0.16 (0.07-0.56)	0.31 (0.08-0.61)	0.58
Albumin, g/L	33.1 (29.5-37.3)	34.7 (30.3-38.4)	31.0 (27.5-34.3)	< 0.001
Total protein, g/L	63.4 (57.8-69.0)	64.0 (58.6-69.4)	61.4 (57.4-67.5)	0.051
ALT, U/L	26 (18-47)	26 (18-51)	26 (19-35)	0.44
AST, U/L	43 (27-71)	41 (25-72)	47 (31-69)	0.11
TBIL, μmol/L	26.3 (16.6-50.2)	22.0 (14.9-38.5)	48.2 (26.8-87.4)	< 0.001
DBIL, μmol/L	11.6 (7.0-23.1)	9.1 (5.9-17.9)	20.6 (11.7-47.1)	< 0.001
BUN, mg/dL	5.59 (4.60-7.29)	5.58 (4.47-7.41)	5.59 (4.76-7.05)	0.94
Serum creatinine, mg/dL	62 (50-76)	62 (53-76)	62 (46-76)	0.40
Glucose, mg/dL	5.30 (4.71-6.44)	5.43 (4.84-6.82)	5.05 (4.56-5.79)	0.002
INR	1.19 (1.07-1.35)	1.14 (1.05-1.27)	1.30 (1.19-1.50)	< 0.001
D-dimer, mg/L	1.3 (0.4-4.2)	1.1 (0.4-4.2)	1.8 (0.8-4.1)	0.016
Prothrombin time, seconds	10.9 (9.7-12.5)	10.4 (9.5-11.8)	12.0 (11.0-13.9)	< 0.001
Prothrombin time activity, %	66 (55-80)	71 (60-83)	58 (47-67)	< 0.001
Sodium, mmol/L	140 (137-142)	140 (137-142)	140 (136-142)	0.39
Ultrasound
Ejection fraction, %	69 (64-73)	69 (63-73)	69 (65-72)	0.671
Cardiac output, L/minute	5.4 (4.3-6.7)	5.0 (4.2-6.1)	6.1 (4.6-7.1)	0.011
E to e’ ratio	9.0 (8.0-11.5)	9.0 (8.0-11.0)	10.0 (8.0-12.5)	0.017
Cardiac index, L/minute/m²	3.05 (2.60-3.80)	2.90 (2.50-3.53)	3.40 (2.80-4.15)	0.003
Portal vein diameter, mm	13.0 (11.1-15.0)	13.0 (11.0-15.0)	13.0 (12.0-15.0)	0.443
Biomarkers
S1P, pg/mL	46 (26-77)	51 (31-85)	33 (18-58)	< 0.001
Angiopoietin-2, pg/mL	3681 (2217-6473)	3110 (1975-5351)	5539 (3286-8805)	< 0.001
VWF, ng/mL	14.3 (7.4-30.5)	13.7 (7.2-29.7)	15.4 (8.9-30.9)	0.312
sE-selectin, ng/mL	18.7 (14.5-24.4)	19.3 (14.8-23.8)	17.1 (14.3-25.1)	0.912
ICAM-1, ng/mL	165 (95-304)	161 (92-280)	201 (104-410)	0.022
PDGF-BB, pg/mL	62 (34-112)	71 (38-123)	45 (25-76)	< 0.001
TNF alpha, pg/mL	42 (37-47)	42 (38-47)	41 (36-47)	0.412
VCAM-1, ng/mL	15.5 (10.0-22.3)	15.3 (10.1-21.2)	16.9 (10.0-23.4)	0.323
VEGF-A, pg/mL	121 (86-204)	117 (82-193)	124 (96-244)	0.062

¹Cause: If a patient has multiple etiologies simultaneously, record them separately.

Normally distributed continuous variables are displayed as the mean ± standard deviation and were compared using the independent samples Student’s t test. Non-normally distributed continuous variables are displayed as the median with interquartile range and were compared using the Mann-Whitney U test. Categorical variables are expressed as counts with percentages and were compared using Pearson’s χ² or Fisher’s exact test. ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; BMI: Body mass index; BUN: Blood urea nitrogen; CAR: C-reactive protein-to-albumin ratio; CRP: C-reactive protein; DBIL: Direct bilirubin; HGB: Hemoglobin; ICAM-1: Intercellular adhesion molecule-1; INR: International normalized ratio; IPVD: Intrapulmonary vascular dilatation; LCR: Lymphocyte-to C-reactive protein ratio; MELD: Model for End-Stage Liver Disease; NAFLD: Non-alcoholic fatty liver disease; NLR: Neutrophil-to-lymphocyte ratio; P(A-a)O₂: Alveolar-arterial oxygen gradient; PaO₂: Partial pressure of oxygen in arterial blood; PaCO₂: Partial pressure of carbon dioxide in arterial blood; PCT: Procalcitonin; PDGF-BB: Platelet-derived growth factor BB; PH: Potential of hydrogen; PLR: Platelet-to-lymphocyte ratio; S1P: Sphingosine 1 phosphate; SII: Systemic inflammation index calculated as (neutrophil count × platelet count)/lymphocyte count; SpO₂: Peripheral oxygen saturation; TBIL: Total bilirubin; TNF: Tumor necrosis factor; VCAM-1: Vascular cell adhesion molecule-1; VEGF-A: Vascular endothelial growth factor A; vWF: Von Willebrand factor; WBC: White blood cell.

Table 2 Baseline characteristics and clinical data after hospitalization of patients with cirrhosis with and without hepatopulmonary syndrome, n (%)

Variables	Total (n = 320)	Without HPS (n = 266)	With HPS (n = 54)	P value
Demographic data
Sex, male	246 (77)	208 (78)	38 (70)	0.21
Age, years	58 (52-65)	59 (53-66)	56 (49-59)	0.006
Weight, kg	69 (60-77)	70 (60-76)	67 (60-79)	0.57
Height, m	1.70 (1.64-1.74)	1.70 (1.64-1.74)	1.69 (1.60-1.75)	0.68
BMI, kg/m²	24.03 (21.58-26.64)	24.17 (21.72-26.73)	23.42 (21.50-26.48)	0.54
Smoke	129 (40)	106 (40)	23 (43)	0.72
Drink	125 (39)	103 (39)	22 (41)	0.80
Cause¹
Alcoholic liver disease	65 (20)	52 (20)	13 (24)	0.45
Hepatitis B	189 (59)	167 (63)	22 (41)	0.003
Hepatitis C	44 (14)	37 (14)	7 (13)	0.85
NAFLD	5 (1.6)	4 (1.5)	1 (1.9)	0.99
Autoimmune hepatitis	26 (8.1)	17 (6.4)	9 (17)	0.024
Other	17 (5.3)	12 (4.5)	5 (9.3)	0.18
Co-morbidities
Hypertension	93 (29)	82 (31)	11 (20)	0.12
Diabetes	91 (28)	81 (30)	10 (19)	0.076
Heart failure	25 (7.8)	19 (7.1)	6 (11)	0.40
Kidney failure	60 (19)	49 (18)	11 (20)	0.74
Liver cancer	193 (60)	169 (64)	24 (44)	0.009
Esophageal varices	201 (63)	137 (63)	34 (63)	0.91
Bleeding	89 (28)	79 (30)	10 (19)	0.095
Ascites	207 (65)	167 (63)	44 (81)	0.005
Hepatic encephalopathy	94 (29)	76 (29)	18 (33)	0.48
Clubbing of the fingers	3 (0.9)	3 (1.1)	0 (0.0)	0.99
Palmar erythema	61 (19)	48 (18)	13 (24)	0.30
Spider angioma	8 (2.5)	6 (2.3)	2 (3.7)	0.63
Disease severity
MELD score	11.1 (5.9-17.8)	9.5 (5.8-15.7)	17.8 (10.6-35.0)	< 0.001
Child-Pugh classification				< 0.001
I	113 (35)	110 (41%)	3 (5.6)
II	147 (46)	117 (44)	30 (56)
III	60 (19)	39 (15)	21 (39)
Decompensated stage	238 (74)	190 (71)	48 (89)	0.007
Arterial blood gas
PH	7.44 (7.42-7.46)	7.43 (7.42-7.45)	7.45 (7.42-7.47)	0.005
P(A-a)O₂, mmHg	16.7 (8.0-26.6)	12.6 (6.6-23.4)	27.0 (24.4-38.0)	< 0.001
PaO₂, mmHg	94.5 (84.6-105.1)	97.9 (87.0-107.4)	83.4 (76.4-87.6)	< 0.001
PaCO₂, mmHg	33.2 (29.9-36.9)	33.8 (30.4-37.3)	31.0 (27.7-33.0)	< 0.001
SpO₂, %	97.6 (96.8-98.3)	97.9 (97.0-98.4)	96.8 (95.6-97.3)	< 0.001
Laboratory parameters
CRP, mg/L	7.27 (2.26-17.74)	5.87 (2.25-17.40)	10.30 (2.30-17.58)	0.44
PCT, ng/mL	0.11 (0.05-0.38)	0.10 (0.05-0.28)	0.25 (0.08-0.90)	0.011
WBC count, × 10⁹/L	4.13 (2.91-6.15)	4.25 (2.93-6.18)	3.91 (2.88-5.52)	0.72
HGB, g/L	115 (95-131)	118 (96-134)	103 (78-117)	< 0.001
Platelet count, × 10⁹/L	80 (55-125)	82 (57-129)	64 (45-99)	0.035
Neutrophil count, × 10⁹/L	2.55 (1.67-4.34)	2.55 (1.68-4.32)	2.52 (1.61-4.35)	0.99
Lymphocyte count, × 10⁹/L	0.84 (0.53-1.25)	0.87 (0.53-1.26)	0.66 (0.42-1.13)	0.019
NLR	2.97 (1.83-6.03)	2.70 (1.78-5.85)	4.27 (2.77-6.99)	0.032
PLR	93.7 (67.2-148.7)	92.5 (67.7-148.7)	102.3 (61.4-148.2)	0.93
LCR	0.11 (0.04-0.34)	0.11 (0.04-0.41)	0.11 (0.04-0.18)	0.26
SII	248 (132-509)	242 (137-493)	280 (100-734)	0.99
CAR	0.20 (0.07-0.58)	0.18 (0.07-0.54)	0.38 (0.08-0.62)	0.21
Albumin, g/L	33.1 (29.5-37.3)	34.1 (30.2-38.0)	29.2 (26.3-33.2)	< 0.001
Total protein, g/L	63.4 (57.8-69.0)	63.7 (58.1-69.2)	61.4 (56.4-68.0)	0.12
ALT, U/L	26 (18-47)	26 (18-48)	24 (18-46)	0.64
AST, U/L	43 (27-71)	41 (26-69)	52 (35-115)	0.022
TBIL, μmol/L	26.3 (16.6-50.2)	23.2 (15.9-42.5)	53.9 (33.3-110.1)	< 0.001
DBIL, μmol/L	11.6 (7.0-23.1)	9.8 (6.5-19.6)	32.2(15.3-81.3)	< 0.001
BUN, mg/dL	5.59 (4.60-7.29)	5.55 (4.48-7.41)	5.70 (4.87-6.97)	0.56
Serum creatinine, mg/dL	62 (50-76)	62 (51-76)	64 (45-84)	0.85
Glucose, mg/dL	5.30 (4.71-6.44)	5.31 (4.76-6.59)	5.27 (4.66-6.08)	0.49
INR	1.19 (1.07-1.35)	1.17 (1.06-1.31)	1.31 (1.20-1.49)	< 0.001
D-dimer, mg/L	1.3 (0.4-4.2)	1.3 (0.4-4.2)	1.3 (0.5-4.5)	0.42
Prothrombin time, seconds	10.9 (9.7-12.5)	10.6 (9.6-12.1)	12.1 (11.2-13.8)	< 0.001
Prothrombin time activity, %	66 (55-80)	9 (57-82)	56 (50-64)	< 0.001
Sodium, mmol/L	140 (137-142)	140 (137-143)	138 (135-140)	< 0.001
Ultrasound
Ejection fraction, %	69 (64-73)	69 (63-73)	68 (64-72)	0.83
Cardiac output, L/minute	5.4 (4.3-6.7)	5.1 (4.2-6.4)	6.6 (4.9-7.5)	0.002
E to e’ ratio	9.0 (8.0-11.5)	9.0 (8.0-11.0)	10.0 (8.0-12.0)	0.45
Cardiac index, L/minute/m²	3.05 (2.60-3.80)	3.00 (2.60-3.70)	3.75 (2.90-4.23)	0.005
Portal vein diameter, mm	13.0 (11.1-15.0)	13.0 (11.1-15.0)	13.0 (11.8-15.3)	0.34
Biomarkers
S1P, pg/mL	46 (26-77)	49 (28-83)	32 (20-51)	0.002
Angiopoietin-2, pg/mL	3681 (2217-6473)	3457 (2074-5741)	6500 (3790-10892)	< 0.001
VWF, ng/mL	14.3 (7.4-30.5)	13.5 (7.3-26.8)	21.4 (8.9-30.9)	0.054
sE-selectin, ng/mL	18.7 (14.5-24.4)	18.7 (14.6-24.0)	19.0 (14.6-25.7)	0.53
ICAM-1, ng/mL	165 (95-304)	159 (90-284)	240 (121-392)	0.008
PDGF-BB, pg/mL	62 (34-112)	63 (35-118)	545 (25-77)	0.022
TNF alpha, pg/mL	42 (37-47)	42 (37-46)	41 (36-48)	0.68
VCAM-1, ng/mL	15.5 (10.0-22.3)	15.5 (10.0-21.4)	18.1 (10.5-24.5)	0.17
VEGF-A, pg/mL	121 (86-204)	117 (83-191)	140 (99-343)	0.008

¹Cause: If a patient has multiple etiologies simultaneously, record them separately.

Normally distributed continuous variables are displayed as the mean ± standard deviation and were compared using the independent samples Student’s t test. Non-normally distributed continuous variables are displayed as the median with interquartile range and were compared using the Mann-Whitney U test. Categorical variables are expressed as counts with percentages and were compared using Pearson’s χ² or Fisher’s exact test. ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; BMI: Body mass index; BUN: Blood urea nitrogen; CAR: C-reactive protein-to-albumin ratio; CRP: C-reactive protein; DBIL: Direct bilirubin; HGB: Hemoglobin; HPS: Hepatopulmonary syndrome; ICAM-1: Intercellular adhesion molecule-1; INR: International normalized ratio; LCR: Lymphocyte-to C-reactive protein ratio; MELD: Model for End-Stage Liver Disease; NAFLD: Non-alcoholic fatty liver disease; NLR: Neutrophil-to-lymphocyte ratio; P(A-a)O₂: Alveolar-arterial oxygen gradient; PaO₂: Partial pressure of oxygen in arterial blood; PaCO₂: Partial pressure of carbon dioxide in arterial blood; PCT: Procalcitonin; PDGF-BB: Platelet-derived growth factor BB; PH: Potential of hydrogen; PLR: Platelet-to-lymphocyte ratio; S1P: Sphingosine 1 phosphate; SII: Systemic inflammation index calculated as (neutrophil count × platelet count)/lymphocyte count; SpO₂: Peripheral oxygen saturation; TBIL: Total bilirubin; TNF: Tumor necrosis factor; VCAM-1: Vascular cell adhesion molecule-1; VEGF-A: Vascular endothelial growth factor A; vWF: Von Willebrand factor; WBC: White blood cell.

Table 3 Univariable logistic regression analysis for the predictors of intrapulmonary vascular dilatation in patients with cirrhosis

Variables	Univariate analysis
Variables	OR (95%CI)	P value
Sex, male	0.475 (0.277-0.812)	0.007
Age, years	0.957 (0.934-0.981)	< 0.001
Weight, kg	0.979 (0.961-0.998)	0.027
BMI, kg/m²	0.946 (0.893-1.003)	0.064
Hepatitis B	0.472 (0.292-0.762)	0.002
Autoimmune hepatitis	2.776 (1.234-6.244)	0.014
Hypertension	0.347 (0.190-0.634)	< 0.001
Diabetes	0.434 (0.242-0.776)	0.005
Liver cancer	0.532 (0.329-0.858)	0.010
Ascites	2.196 (1.291-3.738)	0.004
Hepatic encephalopathy	1.756 (1.060-2.907)	0.029
Palmar erythema	1.822 (1.026-3.236)	0.040
MELD score	1.018 (1.007-1.028)	< 0.001
Child-Pugh classification
I
II	4.352 (2.269-8.345)	< 0.001
III	7.559 (3.554-16.078)	< 0.001
Decompensated stage	2.798 (1.486-5.269)	0.001
PH	12245 (13-11971501)	0.007
P(A-a)O₂	1.028 (1.008-1.048)	0.006
PaCO₂	0.915 (0.870-0.962)	< 0.001
HGB, g/L	0.974 (0.964-0.983)	< 0.001
Platelet count, × 10⁹/L	0.991 (0.986-0.996)	< 0.001
Neutrophil count, × 10⁹/L	0.942 (0.855-1.038)	0.228
Lymphocyte count, × 10⁹/L	0.472 (0.291-0.766)	0.002
SII	1.000 (0.999-1.000)	0.136
Albumin, g/L	0.880 (0.838-0.923)	< 0.001
DBIL, μmol/L	1.004 (1.001-1.007)	0.006
Glucose, mg/dL	0.870 (0.754-1.003)	0.055
INR	6.529 (2.710-15.729)	< 0.001
D-dimer, mg/L	1.000 (1.000-1.001)	0.346
Prothrombin time, seconds	1.164 (1.074-1.261)	< 0.001
Prothrombin time activity, %	0.953 (0.938-0.968)	< 0.001
Cardiac output, L/minute	1.251 (1.059-1.478)	0.009
Effective ejection fraction, %	1.140 (1.028-1.264)	0.013
Cardiac index, L/minute/m²	1.525 (1.128-2.061)	0.006
S1P, pg/mL	0.992 (0.986-0.997)	0.005
Angiopoietin-2, pg/mL	1.000 (1.000-1.000)	< 0.001
VWF, ng/mL	1.000 (1.000-1.000)	0.556
sE-selectin, ng/mL	1.000 (1.000-1.000)	0.909
ICAM-1, ng/mL	1.000 (1.000-1.000)	0.089
PDGF-BB, pg/mL	0.992 (0.988-0.997)	< 0.001
TNF alpha, pg/mL	0.996 (0.982-1.011)	0.600
VCAM-1, ng/mL	1.000 (1.000-1.000)	0.257
VEGF-A, pg/mL	1.001 (1.000-1.001)	0.195

CI: Confidence interval; DBIL: Direct bilirubin; HGB: Hemoglobin; ICAM-1: Intercellular adhesion molecule-1; INR: International normalized ratio; MELD: Model for End-Stage Liver Disease; OR: Odds ratio; P(A-a)O₂: Alveolar-arterial oxygen gradient; PaCO₂: Partial pressure of carbon dioxide in arterial blood; PDGF-BB: Platelet-derived growth factor BB; PH: Potential of hydrogen; S1P: Sphingosine 1 phosphate; SII: Systemic inflammation index calculated as (neutrophil count × platelet count)/lymphocyte count; TNF: Tumor necrosis factor; VCAM-1: Vascular cell adhesion molecule-1; VEGF-A: Vascular endothelial growth factor A; vWF: Von Willebrand factor.

Table 4 Univariable logistic regression analysis for the predictors of hepatopulmonary syndrome in patients with cirrhosis

Variables	Univariate analysis
Variables	OR (95%CI)	P value
Age, years	0.959 (0.931-0.988)	0.006
Hepatitis B	0.408 (0.224-0.740)	0.003
Autoimmune hepatitis	2.929 (1.230-6.979)	0.015
Liver cancer	0.459 (0.254-0.830)	0.010
Ascites	2.780 (1.340-5.767)	0.006
MELD score	1.019 (1.008-1.029)	< 0.001
Child-Pugh classification
I
II	9.402 (2.790-31.687)	< 0.001
III	19.744 (5.580-69.859)	< 0.001
Decompensated stage	3.200 (1.315-7.788)	0.010
PH	2123 (0.517-8719201)	0.071
P(A-a)O₂, mmHg	1.095 (1.065-1.126)	< 0.001
PaO₂, mmHg	0.921 (0.897-0.945)	< 0.001
PaCO₂, mmHg	0.864 (0.808-0.923)	< 0.001
SpO₂, %	0.726 (0.612-0.862)	< 0.001
PCT, ng/mL	1.133 (0.979-1.312)	0.094
HGB, g/L	0.975 (0.964-0.987)	< 0.001
Platelet count, × 10⁹/L	0.995 (0.989-1.001)	0.105
NLR	1.052 (1.001-1.106)	0.044
Albumin, g/L	0.847 (0.797-0.901)	< 0.001
AST, U/L	1.003 (0.999-1.007)	0.127
TBIL, μmol/L	1.004 (1.002-1.007)	< 0.001
DBIL, μmol/L	1.005 (1.002-1.009)	< 0.001
INR	3.457 (1.694-7.055)	< 0.001
Prothrombin time, seconds	1.098 (1.028-1.172)	0.005
Prothrombin time activity, %	0.960 (0.943-0.978)	< 0.001
Sodium, mmol/L	0.894 (0.840-0.952)	< 0.001
Cardiac output, L/minute	1.346 (1.108-1.635)	0.003
Cardiac index, L/minute/m²	1.118 (0.929-1.347)	0.238
S1P	0.991 (0.983-0.999)	0.029
Angiopoietin-2	1.000 (1.000-1.000)	< 0.001
vWF	1.000 (1.000-1.000)	0.762
sE-selectin, pg/mL	1.000 (1.000-1.000)	0.546
ICAM-1, pg/mL	1.000 (1.000-1.000)	0.225
PDGF-BB, pg/mL	0.994 (0.988-0.999)	0.027
TNF alpha, pg/mL	1.000 (0.988-1.012)	0.951
VCAM-1, pg/mL	1.000 (1.000-1.000)	0.133
VEGF-A, pg/mL	1.001 (1.000-1.002)	0.051

AST: Aspartate aminotransferase; CI: Confidence interval; DBIL: Direct bilirubin; HGB: Hemoglobin; ICAM-1: Intercellular adhesion molecule-1; INR: International normalized ratio; MELD: Model for End-Stage Liver Disease; NLR: Neutrophil-to-lymphocyte ratio; OR: Odds ratio; P(A-a)O₂: Alveolar-arterial oxygen gradient; PaO₂: Partial pressure of oxygen in arterial blood; PaCO₂: Partial pressure of carbon dioxide in arterial blood; PCT: Procalcitonin; PDGF-BB: Platelet-derived growth factor BB; PH: Potential of hydrogen; S1P: Sphingosine 1 phosphate; SpO₂: Peripheral oxygen saturation; TBIL: Total bilirubin; TNF: Tumor necrosis factor; VCAM-1: Vascular cell adhesion molecule-1; VEGF-A: Vascular endothelial growth factor A; vWF: Von Willebrand factor; SII: Systemic inflammation index calculated as (neutrophil count × platelet count)/lymphocyte count.

Table 5 Predicted value information of different parameters and the combined model for intrapulmonary vascular dilatation and hepatopulmonary syndrome in patients with cirrhosis

Variables	Cut off value	Sensitivity	Specificity	Accuracy	PPV	NPV	Youden index
Predicting IPVD
Age, years	60	0.68	0.49	0.55	0.38	0.77	0.17
MELD score	9	0.78	0.55	0.63	0.45	0.85	0.33
P(A-a)O₂, mmHg	24	0.52	0.72	0.65	0.49	0.73	0.23
S1P, pg/mL	36	0.58	0.69	0.66	0.46	0.78	0.27
Angiopoietin-2, pg/mL	2922	0.85	0.48	0.60	0.42	0.88	0.33
PDGF-BB, pg/mL	79	0.78	0.46	0.56	0.40	0.82	0.24
The combined model	0.27	0.87	0.59	0.69	0.52	0.90	0.47
Predicting HPS
Age, years	60	0.76	0.47	0.52	0.22	0.91	0.23
P(A-a)O₂, mmHg,	18	0.96	0.64	0.71	0.41	0.99	0.60
HGB, g/L	115	0.72	0.55	0.58	0.25	0.91	0.27
Albumin, g/L	35	0.89	0.45	0.53	0.25	0.95	0.34
TBIL, μmol/L	29	0.81	0.61	0.64	0.30	0.94	0.42
S1P, pg/mL	36	0.61	0.65	0.64	0.26	0.89	0.26
Angiopoietin-2, pg/mL	4373	0.73	0.62	0.64	0.27	0.92	0.35
PDGF-BB, pg/mL	79	0.78	0.41	0.48	0.21	0.90	0.19
Combined model	0.14	0.94	0.74	0.78	0.47	0.98	0.68

HGB; Hemoglobin; HPS: Hepatopulmonary syndrome; IPVD: Intrapulmonary vascular dilatation; MELD: Model for End-Stage Liver Disease; NPV: Negative predictive value; P(A-a)O₂: Alveolar-arterial oxygen gradient; PDGF-BB: Platelet-derived growth factor BB; PPV: Positive predictive value; S1P: Sphingosine 1 phosphate; TBIL: Total bilirubin.

Citation: Wu ZP, Wang YF, Shi FW, Cao WH, Sun J, Yang L, Ding FP, Hu CX, Kang WW, Han J, Yang RH, Song QK, Jin JW, Shi HB, Ma YM. Predictive models and clinical manifestations of intrapulmonary vascular dilatation and hepatopulmonary syndrome in patients with cirrhosis: Prospective comparative study. World J Gastroenterol 2025; 31(15): 105720
URL: https://www.wjgnet.com/1007-9327/full/v31/i15/105720.htm
DOI: https://dx.doi.org/10.3748/wjg.v31.i15.105720