Respiratory muscle strength, hypoxemia and dyspnea in liver cirrhosis patients

BackgroundRespiratory muscle strength, occurrence of chronic dyspnea and hypoxemia are still subjects of debate in liver cirrhosis. The loss of muscle mass in cirrhotic patients may affect respiratory muscles thus contributing to chronic dyspnea in those patients.ObjectiveTo evaluate respiratory muscle strength, occurrence of hypoxemia and chronic dyspnea and their interrelationships in cirrhotic patients.Patients and methodsOne hundred HCV liver cirrhosis patients were recruited. Liver profile, serum creatinine, arterial blood gases (ABG), spirometry, maximal inspiratory (PiMAX) and expiratory (PeMAX) pressures were measured. Grading of dyspnea was done using the modified medical research council (mMRC) scale. The model for end-stage liver disease (MELD) score was calculated for every patient.ResultsPatients’ mean MELD score was 16.9±5.23. Mean mMRC score was 2.18±0.81. Hypoxemia was found in 81 (81%) patients. 39 (39%) and 35 (35%) patients had low PiMAX and PeMAX, respectively, and 37 (37%) patients had low respiratory muscle strength (RMS). mMRC score correlated negatively with RMS (r=−0.767, p<0.001) and PO2 (r=−0.754, p<0.001) but correlated positively with MELD score (r=0.9, p<0.001). MELD score correlated negatively with RMS (r=−0.824, p<0.001) and PO2 (r=−0.824, P<0.001). Patients without ascites had significantly higher PO2, PiMAX, PeMAX and RMS but lower mMRC values than ascitic patients.ConclusionChronic dyspnea and hypoxemia are prevalent in cirrhotic patients and they are correlated with respiratory muscle weakness and liver disease severity. Ascitic patients have worse respiratory muscle function and are more dyspneic than non ascitic patients