Indian Journal of Gastroenterology

, Volume 37, Issue 3, pp 209–214 | Cite as

Raised plasma levels of H2S and nitrate predict intrapulmonary vascular dilations: A preliminary report in patients with cryptogenic cirrhosis

  • Chinmay Bera
  • Kavitha Thangaraj
  • Purendra Kumar Pati
  • Jeyamani Ramachandran
  • K A Balasubramanian
  • Anup Ramachandran
  • Uday Zachariah
  • K G Sajith
  • Ashish Goel
  • C E EapenEmail author
Original Article


Background and Aims

The role of vasoactive chemicals in the pathogenesis of hepatopulmonary syndrome (HPS), a disorder characterized by intrapulmonary vascular dilation (IPVD), is only vaguely elucidated. We aimed to study the association between plasma H2S, nitrate levels, and presence and severity of IPVD and HPS.


Consecutive adult patients with cryptogenic cirrhosis were evaluated for IPVD (by contrast echocardiography) and for hypoxemia (by arterial blood gas analysis). Plasma H2S and nitrate levels were measured in these patients.


Fifty-eight patients with cryptogenic cirrhosis (male, 45; median age, range, 45, 16–74 years; Child’s class; A, 30; B, 18; C, 10) were enrolled in this study. Thirty-four of the 58 (59%) patients had IPVD and 13 (22%) had HPS (mild, 4; moderate, 5; severe, 2; very severe, 2). Plasma H2S levels were significantly higher in patients with IPVD (19.6, 5.7–83 μmol/L) as compared to patients who had no IPVD (12.3, 0–47 μmol/L; p-value 0.03) with an area under receiver operating characteristic curve of 0.68 (95% CI 0.53–0.84). Plasma H2S levels were higher in patients with IPVD irrespective of liver disease severity. There was a trend for higher plasma nitrate levels in patients with IPVD (47, 15.8–126.4 nmol/mL) as compared to patients who had no IPVD (32.3, 6.9–51.4 nmol/mL; p-value 0.1). Raised plasma H2S and nitrate levels had an additive effect on the presence of IPVD. Neither plasma H2S nor plasma nitrate levels correlated with the degree of hypoxemia.


Raised plasma H2S and nitrate levels predict the presence of IPVD in patients with cryptogenic cirrhosis.


Hepatopulmonary syndrome Nitric oxide Sulfate 



The authors wish to acknowledge the role of Professor Elwyn Elias, Liver Unit, University Hospital Birmingham, Birmingham, UK, in study concept and critical revision of the manuscript.

Financial support

Authors acknowledge and thank the financial support rendered by institutional Fluid Research Fund of Christian Medical College, Vellore, India.

Compliance with ethical standards

Conflict of interest

CB, KT, PKP, JR, KAB, AR, UZ, KGS, AG, and CEE declare that they have no conflict of interest.

Ethics statement

The study was performed in a manner to conform with the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on The study protocol was approved by the institutional review board and ethics committee.


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Copyright information

© Indian Society of Gastroenterology 2018

Authors and Affiliations

  • Chinmay Bera
    • 1
  • Kavitha Thangaraj
    • 2
  • Purendra Kumar Pati
    • 3
  • Jeyamani Ramachandran
    • 1
  • K A Balasubramanian
    • 2
  • Anup Ramachandran
    • 2
  • Uday Zachariah
    • 1
  • K G Sajith
    • 1
  • Ashish Goel
    • 1
  • C E Eapen
    • 1
    Email author
  1. 1.Department of HepatologyChristian Medical CollegeVelloreIndia
  2. 2.Wellcome Trust Research LaboratoriesChristian Medical CollegeVelloreIndia
  3. 3.Department of CardiologyChristian Medical CollegeVelloreIndia

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