title: Predictive value of exhaled nitric oxide and aerobic capacity for sepsis complications after liver transplantation.
abstract: Our objective was to investigate the predictive value of fractional nitric oxide (NO) concentration in exhaled breath (FeNO) and aerobic capacity (peak VO2) for postoperative sepsis in liver transplantation candidates. Patients were identified and charts of all consecutive patients were prospectively reviewed. Bacterial sepsis represented the commonest postoperative complications (30%), which was attributed to peritonitis, pneumonia, and catheter-related infections. Preoperative FeNO and peak VO2values were lower in patients with postoperative sepsis. Patients with sepsis required higher needs for mechanical ventilation and ICU length of stay. Inverse correlation was found between logarithmically FeNO-transformed data and systolic pulmonary artery pressure (r = -0.348; P = 0.018). Multivariate analyses using bootstrap sampling method indicated that odds of sepsis were associated with lower values of peak exercise VO2[OR = 0.790 (0.592; 0.925)] and reduced log(FeNo) [OR = 0.027 (0.001; 0.451)], but not with higher MELD scores [OR = 1.141 (0.970; 1.486)]. By evaluating the cutoff for the ROC curves in each bootstrap resampling, median and 95% confidence interval were calculated for peak VO2: 17 [16.2; 22] ml/kg/min and FeNO: 17.2 [13.0; 33.9] ppb. We conclude that low peak exercise VO2and reduced FeNO may help identify patients who are at risk to develop perioperative sepsis.
authors.affiliation: Service d'Explorations Fonctionnelles Respiratoires, Hôpital Calmette, CHU Lille, Lille, France.|Département de Physiologie, Faculté of Médicine - INSERM U995, Université Lille, Lille, France.
authors.forename: Remi
authors.initials: R
authors.lastname: Neviere
authors.affiliation: Pôle d'Anesthésie Réanimation, CHU Lille, Lille, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Trinh-Duc
authors.affiliation: Service d'Explorations Fonctionnelles Respiratoires, Hôpital Calmette, CHU Lille, Lille, France.|Département de Médecine du Travail, EA4483 Faculté of Médicine, Université Lille, Lille, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Hulo
authors.affiliation: Service d'Explorations Fonctionnelles Respiratoires, Hôpital Calmette, CHU Lille, Lille, France.|Département de Médecine du Travail, EA4483 Faculté of Médicine, Université Lille, Lille, France.
authors.forename: Jean Louis
authors.initials: JL
authors.lastname: Edme
authors.affiliation: Pôle d'Anesthésie Réanimation ADRU, CHU Nîmes, Lille, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Dehon
authors.affiliation: Service de Chirurgie Digestive et de Transplantation, Hôpital Huriez, CHU Lille, Lille, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Boleslawski
authors.affiliation: Service des Maladies de l'Appareil Digestif et de la Nutrition, Hôpital Huriez, CHU Lille, Lille, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Dharancy
authors.affiliation: Pôle d'Anesthésie Réanimation, Université de Lille, CHU Lille, EA7365 - GRITA - Groupe de Recherche sur les Formes Injectables et technologies Associées, Lille, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Lebuffe
mesh_terms: D000368:Aged; D062186:Arterial Pressure; D045853:Exhalation; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D017093:Liver Failure / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009569:Nitric Oxide / Q000737:chemistry*; D010101:Oxygen Consumption; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000473:pathology; D012372:ROC Curve; D018805:Sepsis / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology
chemical_list: D009569:Nitric Oxide
keywords: aerobic capacity (VO2max); exhaled nitric oxide; liver transplantation; sepsis