Pulmonary complications in liver disease

Excerpt

Chronic liver disease and impaired hepatic function are important risk factors for increased incidence of, and mortality from, acute pulmonary complications including manifest acute respiratory distress syndrome in approximately 8% of cirrhotics admitted to an intensive care unit (ICU) [1, 2]. While micro-aspiration associated with encephalopathy and hydropic decompensation are well-known triggers for pulmonary complications [3], the more specific consequences of end-stage liver disease on the pulmonary microcirculation, such as hepatopulmonary syndrome (HPS) and portopulmonary hypertension (PoPH), result from either production of or failure to clear a broad range of inflammatory, vasoactive or proliferative/angiogenic mediators [4]. The impact of an altered bile acid pattern induces a shift in the gut microbiome [5] that sheds new light on the molecular basis of the long acknowledged ‘gut–liver–lung axis’ as the “motor of multiple organ failure”. …