Horvartis et al used an elevated von Willebrand Factor antigen (vWF-Ag) to screen patients with cirrhosis for hepatopulmonary syndrome. The authors are from the Medical University of Vienna and the University Medical Center Hamburg-Eppendorf.
Patient selection: stable cirrhosis
Reasons to screen a patient for hepatopulmonary syndrome:
(1) unexplained dyspnea
(2) PaO2 < 80 mm Hg
(3) oxygen saturation <= 97%
An elevated plasma vWF-Ag was seen in patients with hepatopulmonary syndrome with a cutoff >= 328% being 100% sensitive but only 54% specific. The negative predictive value was 100% and positive predictive value 37%
If the patient has a positive screen then the next steps are to perform
