AKURASI PULSE OKSIMETRI UNTUK MENDETEKSI DILATASI VASKULAR INTRAPULMONER (DVIP) PADA PASIEN SIROSIS HATI

Abstract

Hepatopulmonary syndrome (HPS) is a complication of liver cirrhotic in the lung. This clinical
syndrome has three components; liver disease, intrapulmonary vascular dilatation (IPVD), and a defect in
oxygenation. Transthoraxic echocardiography with contras enhancement (CE-TTE) is a gold standart method
but still expensive and difficult to detect IPVD because it needs expertise. Therefore, a simple non-invasive
method to detect IPVD would be desirable. In this study pulse oximetry was evaluated as predictor for
identification of IPVD in patient with liver cirrhotic.
Objective of ythis study is to determine the diagnostic accuracy of pulse oxymetry in detection IPVD
compared with CE-TTE as a gold standart. The diagnostic test was perfomed with pulse oxyimetry in 49
consecutive patient with liver cirrhotic of >17 years old without primary cardiopulmonary diseases. Oxygen
saturation (SO2) was determined using a pulse oximeter in supine and upright position. The IVPD measured by
CE-TTE as gold standard. Measurement of predictor and effect variables were singgle blinded which mean the
different examiner, each of them does not know the result of others. Sensitivity, specificity, positif predictive
value, negative predictive value, accuracy, and likelihood ratio was calculated with computer programmed.
Eight patients (16.3%) had IPVD and fourty (83.7%) without IPVD. The cut off SO2 95.5 % in supine
position can predict IPVD with sensitivity 97.6% (CI 95% 72.8;100.0), specificity 87.5% (CI95% 93.2;100.0),
positif predictive value 87. 0% (CI95% 78.2;96.7) negative predictive value 100% (CI95% 72.8;100.0),
accuracy 95% (CI95% 75.8;100.0), positif likelihood ratio 7.8, and negatif likelhood ratio 0.3. The cut off SO2
93.0 % in upright position can predict IPVD with sensitivity 100% (CI95% 94.2;100.0), specificity 87.5%
(CI95% 78.2;96.7), positif predictive value 100% (CI95% 94.2;102.2), negative predictive value 97.6 %
(CI95% 93.4;100.0), accuracy 97.5%(94.1;100.0), positif likelihood ratio 8, and negatif likelhood ratio 0. The
cut off slope oxygen saturation from supine to upright position ( SO2) 2.5% can predict IPVD with sensitivity
100% (CI95% 97.2;100.1), specificity 95.1% (CI95% 89.1;100.0), positif predictive value 80% (CI95% 52.0;100.0), negative predictive value 100 %, accuracy 100% (97.1;100.0), positif likelihood ratio 20.4, and
negatif likelhood ratio 0. Pulse oxymetry is accurate predictor to detect of IPVD in liver cirrhotic patient
without primary cardiopulmonary disease.