Thorax doi:10.1136/thoraxjnl-2011-200499
  • Exhaled markers
  • Original article

Alveolar concentration of nitric oxide predicts pulmonary function deterioration in scleroderma

  1. Anh Tuan Dinh-Xuan2
  1. 1Department of Internal Medicine, University Paris Pierre et Marie Curie, Saint Antoine Hospital, Paris, France
  2. 2Department of Physiology, University Paris Descartes, Cochin Hospital, Paris, France
  3. 3Department of Rheumatology A, University Paris Descartes, Cochin Hospital, Paris, France
  1. Correspondence to Professor Anh Tuan Dinh-Xuan, Department of Physiology, University Paris Descartes, Cochin Hospital, 27 rue du faubourg Saint-Jacques, 75679 Paris cedex 14, France; anh-tuan.dinh-xuan{at}
  1. Contributors KPT, TH-H, AK, YA, N-NL-D, SD-Q, JC and ATD-X were responsible for data collection, data interpretation and preparation of the report. KPT and AK were responsible for data analysis. All authors contributed to critical revision of the report.

  • Received 21 May 2011
  • Accepted 22 September 2011
  • Published Online First 24 October 2011


Background Respiratory failure is a life-threatening and unpredictable complication of systemic sclerosis (SSc). A study was undertaken to assess the value of alveolar nitric oxide (NO) in predicting the risk of lung function deterioration leading to respiratory failure or death in patients with SSc.

Methods 105 patients with SSc were enrolled in this prospective cohort and were followed longitudinally over a 3-year period during which the risk of occurrence of deleterious events was analysed according to alveolar concentration (CAno), conducting airway output (J′awno) and fractional concentration (FEno0.05) of exhaled NO measured at inclusion. Comparison was made between each NO parameter to predict the occurrence of deleterious events, defined as a 10% decrease in total lung capacity or forced vital capacity from baseline, or death.

Results The area under the receiver operating characteristic curve of CAno to predict the occurrence of the combined events was 0.84 (95% CI 0.76 to 0.92; p<0.001), which was significantly higher than those of J′awno and FEno0.05 (p<0.001). A cut-off of CAno of 5.3 ppb had a sensitivity of 88% and a specificity of 62% for the prediction of the occurrence of combined events during follow-up, and was validated in an independent cohort of patients with SSc. Combined events occurred more frequently in patients whose CAno was >5.3 ppb. The adjusted HR for patients with CAno >5.3 ppb was 6.06 (95% CI 2.36 to 15.53; p<0.001). CAno accurately predicted the occurrence of combined events irrespective of forced vital capacity values or the presence of interstitial lung disease at baseline.

Conclusions Increased CAno accurately identifies patients with SSc with a high risk of developing lung function deterioration and may help to initiate early appropriate treatment.


  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by CPP Ile de France.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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