Clinics and research in hepatology and gastroenterology · 2025
Prevalence and risk factors of portopulmonary hypertension in chronic liver disease: systematic review and meta-analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод пока не подготовлен
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Alsaleh Tareq, Harb Amir, Chapagain Parikshit, Dakkak Bassel, Mann Prachi, Shafique Nouman, Khan Nihal, Almujarkesh Mohamad Khaled, Koteish Ayman
Аннотация
BACKGROUND: Portopulmonary hypertension (PoPH) increases perioperative mortality in liver transplantation, underscoring the need for early detection. To better quantify its burden and improve detection, we performed a systematic review and meta-analysis of studies reporting PoPH prevalence and risk factors among adults with chronic liver disease (CLD).
METHODS: We searched multiple databases through March 2025 for studies reporting the prevalence and risk factors of PoPH in CLD. The primary outcome of interest was the pooled prevalence, while the secondary outcome was risk factors. Standard meta-analysis methods were followed using the random-effects model, generating pooled effect estimates with 95% confidence intervals (CI). Heterogeneity was assessed using the I2% statistic.
RESULTS: A total of 48 studies were included, comprising 16,351 CLD patients (mean age 55.5; 60% males). The pooled prevalence of PoPH on RHC was 2.4 % (95% CI: 1.4, 4.1; I2 = 93.3%), whereas the pooled prevalence on TTE was 8.7% (95% CI: 5.9, 12.7). Significant risk factors for PoPH on TTE were female sex (OR 1.83), autoimmune hepatitis (AIH) (OR 1.92), older age (MD 2.19), and higher INR (MD 0.11). AIH was a significant risk factor for PoPH on RHC (OR 2.28). Meta-regression revealed significant decrease of RHC-based prevalence with time (-0.07% per year; p=0.007). Egger's tests showed no publication bias.
CONCLUSION: PoPH confirmed by RHC is uncommon but appears overestimated by TTE. Females, patients with AIH, older age, and coagulopathy may benefit from earlier screening. Standardized echocardiographic thresholds and prospective multicenter studies are needed to refine prevalence and risk prediction.
METHODS: We searched multiple databases through March 2025 for studies reporting the prevalence and risk factors of PoPH in CLD. The primary outcome of interest was the pooled prevalence, while the secondary outcome was risk factors. Standard meta-analysis methods were followed using the random-effects model, generating pooled effect estimates with 95% confidence intervals (CI). Heterogeneity was assessed using the I2% statistic.
RESULTS: A total of 48 studies were included, comprising 16,351 CLD patients (mean age 55.5; 60% males). The pooled prevalence of PoPH on RHC was 2.4 % (95% CI: 1.4, 4.1; I2 = 93.3%), whereas the pooled prevalence on TTE was 8.7% (95% CI: 5.9, 12.7). Significant risk factors for PoPH on TTE were female sex (OR 1.83), autoimmune hepatitis (AIH) (OR 1.92), older age (MD 2.19), and higher INR (MD 0.11). AIH was a significant risk factor for PoPH on RHC (OR 2.28). Meta-regression revealed significant decrease of RHC-based prevalence with time (-0.07% per year; p=0.007). Egger's tests showed no publication bias.
CONCLUSION: PoPH confirmed by RHC is uncommon but appears overestimated by TTE. Females, patients with AIH, older age, and coagulopathy may benefit from earlier screening. Standardized echocardiographic thresholds and prospective multicenter studies are needed to refine prevalence and risk prediction.