Rodriguez-Roisin and Krowka listed criteria for diagnosing and grading the severity of the hepatopulmonary syndrome. The authors are from the University of Barcelona and the Mayo Clinic.


Criteria for the hepatopulmonary syndrome:

(1) severe liver disease

(2) pulmonary vascular defect by contrast-enhanced echocardiography and/or radioactive lung-perfusion scanning

(3) oxygenation defect with the alveolar-arterial oxygen gradient (PAO2 - PaO2) >= 15 mm Hg while breathing ambient air



• Breathing ambient air is based on being at or near sea level.

• Most patients with hepatopulmonary syndrome have cirrhosis with portal hypertension. However, it can also occur with portal hypertension without cirrhosis, hepatitis and acute hepatic failure.

PaO2 on ambient air


>= 80 mm Hg


60 to 79.9 mm Hg


50 to 59.9 mm Hg


< 50 mm Hg

very severe


With very severe disease, PaO2 is < 300 mm Hg when breathing 100% oxygen.


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