Fractional exhaled Nitric Oxide (FeNO) level as a predictor of COVID-19 disease severity

Objective: To assess the feasibility of Fractional exhaled Nitric Oxide (FeNO) as a simple, non-invasive, costeffective and portable biomarker and decision support tool for risk stratification of COVID-19 patients. Methods: We conducted a single-center prospective cohort study of COVID-19 patients whose FeNO levels were measured upon ward admission by the Vivatmo-me handheld device. Demographics, COVID-19 symptoms, and relevant hospitalization details were retrieved from the hospital databases. The patients were divided into those discharged to recover at home and those who died during hospitalization or required admission to an intensive care unit, internal medicine ward, or dedicated facility (severe outcomes group). Results: Fifty-six patients were enrolled. The only significant demographic difference between the severe outcomes patients (n = 14) and the home discharge patients (n = 42) was age (64.21 +/- 13.97 vs. 53.98 +/- 15.57 years, respectively, P = .04). The admission FeNO measurement was significantly lower in the former group compared with the latter group (15.86 +/- 14.74 vs. 25.77 +/- 13.79, parts per billion [PPB], respectively, P = .008). Time to severe outcome among patients with FeNO measurements <11.8 PPB was significantly shorter compared with patients whose FeNO measured >11.8 PPB (19.25 +/- 2.96 vs. 24.41 +/- 1.09 days, respectively, 95% confidence interval [CI] 1.06 to 4.25). An admission FeNO <11.8 PPB was a significant risk factor for severe outcomes (odds ratio = 12.8, 95% CI: 2.78 to 58.88, P = .001), with a receiver operating characteristics curve of 0.752. Conclusions: FeNO measurements by the Vivatmo-me handheld device can serve as a biomarker and COVID-19 support tool for medical teams. These easy-to-use, portable, and noninvasive devices may serve as valuable ED bedside tools during a pandemic.

Automated summary

FeNO measurements using the Vivatmo-me handheld device can serve as a biomarker and decision support tool for risk stratification of COVID-19 patients. Lower FeNO levels upon admission are associated with severe outcomes and can serve as a predictive factor for severe outcomes.