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(Chest. 2004;125:2160-2168.)
© 2004 American College of Chest Physicians

Increased Arteriovenous Carboxyhemoglobin Differences in Patients With Inflammatory Pulmonary Diseases*

Hiroyasu Yasuda, MD; Takahiko Sasaki, MD; Mutsuo Yamaya, MD; Satoru Ebihara, MD; Masahiro Maruyama, MD; Akio Kanda, MD and Hidetada Sasaki, MD, FCCP

* From the Department of Geriatric and Respiratory Medicine, Tohoku University School of Medicine, Sendai, Japan.

Correspondence to: Hidetada Sasaki, MD, Professor and Chairman, Department of Geriatric and Respiratory Medicine, Tohoku University School of Medicine, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan; e-mail: dept{at}geriat.med.tohoku.ac.jp

Purpose: Exhaled carbon monoxide and arterial blood carboxyhemoglobin concentrations increase in inflammatory pulmonary diseases. The present study was undertaken to elucidate whether arteriovenous carboxyhemoglobin (a-vHb-CO) concentration differences are also useful to define the site of inflammation, either in the lung or organs other than the lung.

Materials and methods: We examined concentrations of carboxyhemoglobin in both arterial and peripheral venous blood and exhaled carbon monoxide in patients with acute pulmonary inflammation including bronchial asthma (n = 18) and pneumonia (n = 33), and those in patients with extrapulmonary inflammatory diseases, including acute pyelonephritis (n = 28) and active rheumatoid arthritis (n = 16).

Results: The values of carboxyhemoglobin in both arterial and peripheral venous blood were significantly higher in patients with pulmonary and extrapulmonary inflammation compared with those in control subjects (n = 22). Furthermore, a-vHb-CO differences in patients with inflammatory pulmonary diseases were higher than those in patients with acute pyelonephritis and patients with rheumatoid arthritis, and than those in control subjects. The a-vHb-CO differences correlated with the WBC count of peripheral venous blood in patients with pneumonia. In patients with bronchial asthma, the a-vHb-CO differences inversely correlated with FEV1, although they did not correlate with WBC count of peripheral venous blood. The a-vHb-CO differences in patients with acute pyelonephritis were higher than those in patients with active rheumatoid arthritis.

Conclusion: The present study suggests that a-vHb-CO differences may be a useful means to define the site of inflammation, either in the lung or organs other than the lung, in patients with a fever of unknown origin. The large a-vHb-CO differences may be caused by carbon monoxide production in pulmonary inflammation.

Key Words: carboxyhemoglobin • heme oxygenase • inflammatory pulmonary disease




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