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This Article Full Text Full Text (PDF) All Versions of this Article: 107/1/139    most recent 91621.2008v1 Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Degano, B. Articles by Rivière, D. PubMed PubMed Citation Articles by Degano, B. Articles by Rivière, D.

Nitric oxide and carbon monoxide lung transfer in patients with advanced liver cirrhosis

¹Service de Pneumologie et Réanimation Respiratoire, Centre National de Référence de l'Hypertension Artérielle Pulmonaire, Hôpital Antoine-Béclère, Clamart; ²Service d'Exploration Fonctionnelle Respiratoire, CHU Larrey, Toulouse; ³Laboratoire de Physiologie, Université Victor Segalen Bordeaux II, Bordeaux; ⁴Département de Néphrologie, Dialyse et Transplantation d'Organes, CHU Rangueil, Toulouse; ⁵Département d'Hépato-Gastro-Entérologie, CHU Purpan, Toulouse, France

Submitted 19 December 2008 ; accepted in final form 7 May 2009

In advanced cirrhosis, decreased lung transfer for carbon monoxide (TLCO) and increased alveolar-arterial oxygen tension difference (PA-aO₂ 15 mmHg while breathing ambient air) are frequently detected. Pulmonary membrane diffusion capacity for CO (DmCO) and pulmonary capillary blood volume (Vcap) can be derived from the simultaneous measurement of TLCO and lung transfer for nitric oxide (TLNO). Measurements of single-breath TLNO and TLCO were performed in 49 cirrhotic patients with advanced liver cirrhosis and in 35 healthy controls to derive Vcap, DmCO, and TLNO:TLCO ratio. Twenty-five patients had increased PA-aO₂, of whom 11 had hepatopulmonary syndrome (HPS). Compared with controls, non-HPS patients with normal PA-aO₂ had a significant 10% decrease in TLCO, DmCO, and Vcap but similar TLNO:TLCO ratios. Compared with non-HPS patients with normal PA-aO₂, non-HPS patients with increased PA-aO₂ had lower Vcap and higher TLNO:TLCO ratio but similar DmCO. HPS patients had lower Vcap and higher TLNO:TLCO ratios than both subgroups of non-HPS patients. In cirrhotic patients, TLNO:TLCO ratios correlated positively, and TLCO (percentage of the predicted value) and Vcap (percentage of the predicted value) correlated negatively with PA-aO₂ (r² = 0.25, P = 0.0003, r² = 0.48, P < 0.0001 and r² = 0.57, P < 0.0001, respectively). We concluded that, in cirrhotic patients, lower TLCO and increased PA-aO₂ are associated with lower Vcap. In addition, high TLNO:TLCO ratios in patients with increased PA-aO₂ suggest a decreased thickness of the capillary blood layer in these patients.

capillary blood volume