Abstract
Objective To investigate the clinical value of fractional exhaled nitric oxide (FeNO) in the diagnosis of pulmonary hypertension (PH) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods In this study, the medical records of AECOPD patients were retrospectively reviewed. The patients were divided into AECOPD and AECOPD + PH groups based on the absence or presence of PH. Moreover, FeNO and other indexes were compared between the two groups. The value of FeNO in diagnosing AECOPD with PH was determined using the ROC curve. Results A total of 83 patients were enrolled (56 in the AECOPD group and 27 in the AECOPD + PH group). The level of FeNO was significantly lower in the AECOPD + PH group than in the AECOPD group (P = 0.022). Moreover, FeNO level (25.22 ± 8.45 ppb) was higher in the mild PH subgroup than in the moderate (16.64 ± 5.67 ppb, P = 0.005) or severe (11.75 ± 2.36, P = 0.002) PH subgroups. FeNO level was positively correlated with C-reactive protein in AECOPD patients while negatively correlated with brain natriuretic peptide in the AECOPD + PH group. ROC analysis showed that the optimal cutoff value of FeNO in the diagnosis of AECOPD with PH was 24.5 ppb. Conclusion FeNO level at admission can act as an indicator for PH diagnosis in AECOPD patients.
Highlights
Chronic obstructive pulmonary disease (COPD) is a common respiratory disease and the fourth leading cause of death globally
fractional exhaled nitric oxide (FeNO) level was significantly lower in the Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) + pulmonary hypertension (PH) group than in the AECOPD group (P 0.022)
FeNO level was positively correlated with C-reactive protein (CRP) level in AECOPD patients, while it was negatively correlated with brain natriuretic peptide (BNP) in AECOPD patients with PH. e optimal cutoff value of FeNO in PH diagnosis in AECOPD patients was 24.5 ppb, indicating that FeNO can be used to diagnose AECOPD patients with PH
Summary
Chronic obstructive pulmonary disease (COPD) is a common respiratory disease and the fourth leading cause of death globally. It may be the third leading cause of death in 2020 [1]. There are about 100 million COPD patients in China. COPD is a chronic airway inflammatory disease characterized by chronic cough, expectoration, and dyspnea. COPD patients commonly have acute exacerbations 0.5–3.5 times a year [3]. Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) increases the inflammatory mediators, leading to airway mucosal congestion and edema, airway secretions, aggravates airway obstruction, increases alveolar pressure and pulmonary vascular resistance, and eventually leads to pulmonary hypertension (PH). AECOPD progression results in declined cardiopulmonary function, shorter survival, and higher mortality [4, 5]
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