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Increased Nitric Oxide in the Exhaled Air of Patients with Decompensated Liver Cirrhosis

Akihiro Matsumoto; Keiji Ogura; Yasunobu Hirata; Masao Kakoki; Fumiyoshi Watanabe; Katsu Takenaka; Yasushi Shiratori; Shin-ichi Momomura; and Masao Omata
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From the University of Tokyo, Tokyo, Japan. Requests for Reprints: Yasunobu Hirata, MD, The Second Department of Internal Medicine, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113, Japan. Grant Support: In part by a Grant-in-Aid for Scientific Research on Priority Areas and by Grant-in-Aid 06274209 and 06671132 from the Ministry of Education, Culture, and Science of Japan.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1995;123(2):110-113. doi:10.7326/0003-4819-123-2-199507150-00005
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Objective: To determine if nitric oxide output in exhaled air is increased in patients with liver cirrhosis.

Design: Cross-sectional study.

Setting: A university hospital.

Patients: 50 patients with liver cirrhosis, 6 patients with chronic hepatitis, and 15 healthy controls.

Measurements: Nitric oxide in exhaled air was measured using a chemiluminescence analyzer. Cardiac index was determined using echocardiography.

Results: Patients with decompensated liver cirrhosis had higher levels of exhaled nitric oxide output (Child C patients, 190 ±11 nL/min per m2 body surface area) than controls (97 ±8 nL/min per m2 body surface area; P < 0.001), whereas patients with compensated liver cirrhosis or chronic hepatitis had levels of nitric oxide output similar to those found in controls. Cardiac index was greater in patients with liver cirrhosis (Child C patients, 4.3 ±0.3 L/min per m2 body surface area) than in controls (2.9 ±0.2 L/min per m2 body surface area; P < 0.001). Cardiac index correlated with nitric oxide levels (r = 0.621; P < 0.001).

Conclusions: Increased nitric oxide output in exhaled air is associated with systemic circulatory disturbances in patients with liver cirrhosis.


Grahic Jump Location
Figure 1.
Nitric oxide (NO) output in exhaled air in controls, patients with chronic hepatitis (CH), and patients with liver cirrhosis.

Bars indicate mean with 95% CI.

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Figure 2.
Relation between nitric oxide (NO) output and cardiac index in patients with liver cirrhosis and controls.
Grahic Jump Location




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