Exhaled nitric oxide and oxygenation abnormalities in hepatic cirrhosis

Impaired arterial oxygenation, ranging from increased alveolar‐arterial oxygen gradient (AaDo2) to hypoxemia, is commonly present in patients with cirrhosis. Nitric oxide (NO), through pulmonary vasodilatation, may play a major role in the oxygen abnormalities of cirrhosis. Our aim was to study the...

Full description

Saved in:
Bibliographic Details
Published in:Hepatology (Baltimore, Md.) Md.), 1997-10, Vol.26 (4), p.842-847
Main Authors: Rolla, G, Brussino, L, Colagrande, P, Dutto, L, Polizzi, S, Scappaticci, E, Bergerone, S, Morello, M, Marzano, A, Martinasso, G, Salizzoni, M, Bucca, C
Format: Article
Language:English
Subjects:
Adult
Biological and medical sciences
Echocardiography
Female
Gastroenterology. Liver. Pancreas. Abdomen
Humans
Liver Cirrhosis - metabolism
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Male
Medical sciences
Middle Aged
Nitrates - blood
Nitric Oxide - metabolism
Nitrites - blood
Other diseases. Semiology
Oxygen - metabolism
Citations: Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Impaired arterial oxygenation, ranging from increased alveolar‐arterial oxygen gradient (AaDo2) to hypoxemia, is commonly present in patients with cirrhosis. Nitric oxide (NO), through pulmonary vasodilatation, may play a major role in the oxygen abnormalities of cirrhosis. Our aim was to study the relationship between NO production and O2 abnormalities in 45 nonsmoking patients with cirrhosis and without major cardiovascular and respiratory diseases. Intrapulmonary shunting was detected by contrast‐enhanced (CE) echocardiography. Lung volumes and diffusion, arterial blood gas analysis, serum NO2‐/NO3‐, NO output in the exhaled air, and cardiac index by the echocardiographic method were determined in all patients. Twenty‐seven (60%) patients had an abnormally increased (> 15 mm Hg) AaDo2. The mean values of exhaled NO output and serum NO2‐/NO3‐ were significantly higher in cirrhotic patients than in controls (252 ± 117 vs. 75.2 ± 19 nL/min/m2, P < .0001; and 47.5 ± 29.4 vs. 32.9 ± 10.1 µmol/L, P < .02, respectively). In all patients, there was a significant correlation between exhaled NO and AaDo2 (r = .78, P < .0001). Twelve patients (26.6%) were found to have CE‐echocardiographic evidence of intrapulmonary shunting (positive CE‐echo). Nine patients were considered to have hepatopulmonary syndrome (HPS) on the basis of an AaDo2 > 15 mm Hg and positive CE‐echo. These 9 patients had a mean value of exhaled NO significantly higher than patients without HPS (331 ± 73.2 vs. 223 ± 118.4 nL/min/m2, P < .05). In all patients, cardiac index was positively correlated with exhaled NO (r = .47, P < .001) and with serum NO2‐/NO3‐ (r = .43, P < .01). The results suggest an important role of NO in the oxygenation and circulatory abnormalities of patients with cirrhosis.
ISSN:0270-9139
1527-3350
DOI:10.1002/hep.510260406