Abstract
BackgroundDiscriminating acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) from cardiogenic pulmonary edema (CPE) is often challenging. This systematic review examines studies using biomarkers or images to distinguish ALI/ARDS from CPE.MethodsThree investigators independently identified studies designed to distinguish ALI/ARDS from CPE in adults. Studies were identified from PubMed, and the Cochrane Central Register of Controlled Trials database until July 3, 2017.ResultsOf 475 titles and abstracts screened, 38 full texts were selected for review, and we finally included 24 studies in this systematic review: 21 prospective observational studies, two retrospective observational studies, and one retrospective combined with prospective study. These studies compared various biomarkers to differentiate subjects with ALI/ARDS and in those with CPE, and 13 calculated the area under the receiver operator characteristic curve (AUC). The most commonly studied biomarker (four studies) was brain natriuretic peptide (BNP) and the discriminatory ability ranged from AUC 0.67–0.87 but the timing of measurement varied. Other potential biomarkers or tools have been reported, but only as single studies.ConclusionsThere were no identified biomarkers or tools with high-quality evidence for differentiating ALI/ARDS from CPE. Combining clinical criteria with validated biomarkers may improve the predictive accuracy.
Highlights
Discriminating acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) from cardiogenic pulmonary edema (CPE) is often challenging
We included 24 studies in this systematic review: ten studies using systemic biomarkers which were measured in plasma [the quality of these studies by the modified Hayden’s criteria was, good (n = 6) [10, 16,17,18,19,20], moderate (n = 1) [21], and poor (n = 3) [22,23,24]], and 11 studies using “lung-specific” biomarkers measured in bronchoalveolar lavage (BAL) or pulmonary edema fluid [quality was good (n = 2) [25, 26] and poor (n = 9) [27,28,29,30,31,32,33,34,35]], three studies of chest ultrasonography or computed tomography (CT) [good (n = 1) [36] and moderate (n = 2) [37, 38]]
We identified that some biomarkers, e.g., soluble suppression of tumorigencity-2, brain natriuretic peptide (BNP) plus C-reactive protein (CRP), heparinbinding protein, and plasma transferrin had high Area under the curve (AUC) for differentiating ALI/ARDS from CPE, but these were each only assessed in a single study
Summary
Discriminating acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) from cardiogenic pulmonary edema (CPE) is often challenging. This systematic review examines studies using biomarkers or images to distinguish ALI/ARDS from CPE. Differentiating between cardiogenic pulmonary edema (CPE) and acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) is challenging in the early stages of illness [1]. The ARDS Clinical Trial Network reported that fluid management to decrease cardiogenic fluid retention and the effects of lung permeability and edema, will shorten the duration of mechanical ventilation and intensive care without increasing nonpulmonary organ failure [12]. Several biomarkers to distinguish ALI/ARDS from CPE have been reported. The aim of this systematic review was to review published studies of potential biomarkers to distinguish ALI/ ARDS from CPE
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