Open AccessPredictive value of exhaled nitric oxide and aerobic capacity for sepsis complications after liver transplantation
Author(s) -
Neviere Remi,
TrinhDuc Pierre,
Hulo Sébastien,
Edme Jean Louis,
Dehon Aurélie,
Boleslawski Emmanuel,
Dharancy Sébastien,
Lebuffe Gilles
Publication year - 2016
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.12861
Subject(s) - medicine , sepsis , liver transplantation , confidence interval , pulmonary artery catheter , odds ratio , exhaled nitric oxide , perioperative , mechanical ventilation , gastroenterology , transplantation , surgery , blood pressure , lung , cardiac output , lung function
Summary Our objective was to investigate the predictive value of fractional nitric oxide ( NO ) concentration in exhaled breath (Fe NO ) and aerobic capacity (peak VO 2 ) 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 Fe NO and peak VO 2 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 Fe NO ‐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 VO 2 [ 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 VO 2 : 17 [16.2; 22] ml/kg/min and Fe NO : 17.2 [13.0; 33.9] ppb. We conclude that low peak exercise VO 2 and reduced Fe NO may help identify patients who are at risk to develop perioperative sepsis.