From the Research
The diagnosis of Acute Respiratory Distress Syndrome (ARDS) in patients with Chronic Liver Disease (CLD) should begin with a thorough clinical assessment, including vital signs, physical examination, and review of the patient's history, to identify both common and liver-specific causes, as recommended by recent studies 1. The approach to diagnosing the cause of ARDS in CLD patients involves several key steps:
- Initial diagnostic testing should include arterial blood gas analysis to confirm hypoxemia (PaO2/FiO2 ratio ≤300 mmHg), chest imaging (preferably CT scan) to identify bilateral infiltrates not fully explained by effusions or collapse, and echocardiography to exclude cardiogenic pulmonary edema.
- Specific investigations for CLD patients should include blood cultures, sputum cultures, and bronchoalveolar lavage to identify infectious causes, particularly spontaneous bacterial peritonitis, pneumonia, or opportunistic infections, as highlighted in studies such as 2 and 3.
- Evaluate for aspiration by reviewing recent sedation or encephalopathy episodes, and consider hepatopulmonary syndrome and portopulmonary hypertension as liver-specific causes.
- Check for hepatorenal syndrome, which may contribute to fluid overload, and assess for transfusion-related acute lung injury if the patient has received blood products.
- Measure serum ammonia levels to evaluate for hepatic encephalopathy, which may contribute to respiratory compromise, and monitor liver-specific biomarkers (bilirubin, albumin, INR) to assess liver function deterioration, which can worsen ARDS, as noted in 4 and 5. This comprehensive approach helps identify the underlying cause of ARDS in CLD patients, enabling targeted treatment strategies beyond supportive care, with the goal of improving morbidity, mortality, and quality of life outcomes.