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

Abstract

Our objective was to investigate the predictive value of fractional nitric oxide (NO) concentration in exhaled breath (FeNO) and aerobic capacity (peak VO ) 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 VO 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 VO [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 : 17 [16.2; 22] ml/kg/min and FeNO: 17.2 [13.0; 33.9] ppb. We conclude that low peak exercise VO and reduced FeNO may help identify patients who are at risk to develop perioperative sepsis.

Risk Factors for Sepsis Based on Sepsis-3 Criteria after Orthotopic Liver Transplantation

“…Many factors have been proposed as potential predictors of LT-related sepsis, including exhaled nitric oxide, aerobic capacity, plasma amino acid profile, and muscle wasting [ 8 – 10 ]. However, most of these risk factors concern only the postoperative period, and the value of these reports has been limited by the lack of a clear definition of postoperative sepsis.…”

Physical Fitness as a Prognostic Marker for Infectious Events in Kidney Transplant Recipients

“…Indeed, some studies have already found an association between CRF, expressed as VO 2 peak, and immunological status or risk of infections in other study populations [17-19, 27, 28]. In patients awaiting liver transplantation, low CRF has been found to be a significant predictor for infectious and septic perioperative events [16, 17]; even other infections, such as periodontitis has been associated with poor CRF [27]. In patients with ESKD, however, no data regarding a possible correlation between poor CRF and infectious events has yet been published [29, 30].…”

“…CRF has already been associated with the risk of infectious events in some populations [16, 17]. Previous studies demonstrated that VO 2 peak directly correlated with the proportion of CD4+ naive T-cells, leading to a favorable immunological environment through the prevention of the age-associated decline in immune function (immunosenescence) [18, 19].…”

Survival Outcome of Sepsis in Recipients of Solid Organ Transplant

“…Over the last decade, several potential predictors of sepsis in the posttransplant period have been described: muscle wasting, nitric oxide, aerobic capacity, and plasma amino acid profile. [27][28][29] Candel et al showed that age (>50 years), nosocomial infections, and lung infections are predictors of septic shock in SOT recipients. 30 But each allograft has specific pathophysiologic predictors of sepsis and outcomes.…”