Value Of Fractional Nitric Oxide Research Articles

Predictive value of exhaled nitric oxide and aerobic capacity for sepsis complications after liver transplantation.

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 VO2 values 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 VO2 and reduced FeNO may help identify patients who are at risk to develop perioperative sepsis.

Determination of Normative Values of Fractional Nitric Oxide in Exhaled Breath (FeNO) in Healthy Indian Population

SESSION TITLE: Allergy - Asthma Slide SESSION TYPE: Original Investigation Slide PRESENTED ON: Wednesday, October 26, 2016 at 07:30 AM - 08:30 AM PURPOSE: Fractional nitric oxide in exhaled breath (FENO) is increased in diseases with airway inflammation, especially eosinophilic inflammation. To assess the utility of FENO in disease we need to know its normal value in healthy individuals. American thoracic society (ATS) has given upper limit of normal FENO values as 50 ppb but studies have shown variability in FENO values among different populations. There is no data available about FENO values in healthy Indians. METHODS: Study was conducted at a tertiary care centre in Delhi, India. Four hundred healthy non-smoking adults (age ≥18 years) with normal spirometry were enrolled. The subjects included medical students, hospital staff and patient relatives. Individuals with previous history of respiratory illness, allergic rhinits, atopy and family history of asthma were excluded. All underwent anthropometry and fractional exhaled nitric oxide measurement using hand held NIOX MINO - point of care device (electrochemical sensor based gas analyser). Population was divided into three arbitrary age groups - ≤ 30 years, 31-49 years and ≥50 years. Mann-Whitney U test was done for in-between group comparisons and Spearman’s correlation coefficient was assessed between FENO and various parameters. RESULTS: The mean age of sampled population was 39.6 ± 15.1 years and 263 (65.7%) were males. The median FENO value was 21 ppb (IQR 16-26, range 5-106) with upper and lower limit of normal being 41.5 ppb and 10 ppb respectively. The number of subjects in ≤ 30 years, 30-49 years and > 50 years age groups were 144, 123 and 133 respectively. The median (range, ULN) FENO value in subjects ≤ 30 years, 30-49 years and > 50 years age groups was 20 (6-106, 45) ppb, 22 (5-57, 41) ppb and 22 (7-103, 41) ppb respectively (p = 0.09). FENO values were significantly higher in males [median (IQR) 22 (18-28) ppb] compared to females [median (IQR) 18 (13-23) ppb] (p = 0.001). FENO correlated significantly with height, weight, FEV1 and FVC with correlation coefficients of 0.21 (p<0.001), 0.11 (p=0.02), 0.16 (p<0.001) and 0.18 (p<0.001) respectively. CONCLUSIONS: Upper limit of normal cut-off for FENO in healthy Indians was found to be 41.5 ppb and values above this in an individual will merit further investigation to assess for airway inflammatory states. CLINICAL IMPLICATIONS: Elucidation of normal FENO value in healthy Indian population will help in identifying individuals with airway inflammation among those presenting with respiratory symptoms. DISCLOSURE: The following authors have nothing to disclose: Saurabh Mittal, Anant Mohan, Randeep Guleria, Karan Madan, Vijay Hadda, Gopi Khilnani No Product/Research Disclosure Information

Predictive value of fractional nitric oxide in asthma diagnosis-subgroup analyses

BackgroundThere are no studies investigating the benefit of using FeNO measurements in correlation with sensitization to perennial and seasonal allergens in children with asthma. ObjectiveTo define the group of children with respiratory symptoms in whose FeNO measurement has predictive value for asthma. We assessed the effect of age, allergy profile, atopy, lung function and the presence of allergic rhinitis on interpretation of FeNO levels for clinical applications. MethodsIt was a retrospective, cross-sectional study. We evaluated data from medical documentation of 1767 children with symptoms of allergic diseases such as asthma and/or allergic rhinitis. We included in the analyses subjects who had the following tests done during diagnostic procedures (single measurement): FeNO, spirometry, specific IgE results. All subjects had undergone a minimum 3-years prospective clinical observation after the first FeNO measurement until the later assignment (or not) of an asthma/allergic rhinitis diagnosis. ResultsWe included 1767 children into the analysis; asthma diagnosis was confirm in 1054 (59.6%) children. We showed that only atopy (OR: 1.9; 95%CI: 1.5–2.4) and presence of allergic rhinitis (OR: 1.6; 95%CI: 1.4–1.9) were independently associated with increased FeNO level. Only among patients with atopy and allergic rhinitis FeNO level (above 23ppb) was associated with asthma diagnosis. Sensitivity, specificity, positive predictive value and negative predictive value of FeNO >23ppb for asthma diagnosis were as follows: 0.9(95%CI: 0.68–0.98), 0.52(95%CI: 0.42–0.61), 0.25(95%CI: 0.16–0.37), 0.97(95%CI: 0.88–0.99). ConclusionWe showed that in children with atopy and with allergic rhinitis a negative predictive value for asthma diagnosis was very high with the optimal cut-off point of FeNO 23ppb. Therefore we showed the utility of FeNO measurements to exclude asthma in the subgroup of patients with atopy and allergic rhinitis.