Abstract
BackgroundWe studied the value of routine biochemical variables albumin, C-reactive protein (CRP) and lactate dehydrogenase (LDH) to improve prediction and monitoring of acute respiratory distress syndrome (ARDS) severity in the intensive care unit.MethodsIn 101 critically ill patients, with or at risk for ARDS after new onset fever, data were collected on days (D) 0, 1, 2, and 7 after inclusion. ARDS was defined by the Berlin definition and lung injury score (LIS).ResultsAt baseline, 48 patients had mild to severe ARDS according to Berlin and 87 according to LIS (Rs = 0.54, P < 0.001). Low baseline albumin levels were moderately associated with maximum Berlin and LIS categories within 7 days; an elevated CRP level was moderately associated with maximum Berlin categories only. The day-by-day Berlin and LIS categories were inversely associated with albumin levels (P = 0.01, P < 0.001) and directly with CRP levels (P = 0.02, P = 0.04, respectively). Low albumin levels had monitoring value for ARDS severity on all study days (area under the receiver operating characteristic curve, AUROC, 0.62-0.82, P < 0.001-0.03), whereas supranormal CRP levels performed less . When the Berlin or LIS category increased, albumin levels decreased ≥1 g/L (AUROC 0.72-0.77, P = 0.001) and CRP increased ≥104 mg/L (only significant for Berlin, AUROC 0.69, P = 0.04). When the LIS decreased, albumin levels increased ≥1 g/L (AUROC 0.68, P = 0.02). LDH was higher in 28-day non-survivors than survivors (P = 0.007).ConclusionsOverall, albumin may be of greater value than CRP in predicting and monitoring the severity and course of ARDS in critically patients with or at risk for the syndrome after new onset fever. Albumin levels below 20 g/L as well as a decline over a week are associated with ARDS of increasing severity, irrespective of its definition. LDH levels predicted 28-day mortality.
Highlights
We studied the value of routine biochemical variables albumin, C-reactive protein (CRP) and lactate dehydrogenase (LDH) to improve prediction and monitoring of acute respiratory distress syndrome (ARDS) severity in the intensive care unit
Positive end-expiratory pressure (PEEP) and compliance are incorporated in the lung injury score (LIS) [3], which may constitute a refined but more complex measure of clinical severity that correlates with alveolocapillary permeability and can be assessed at the bedside if the measurement technique is available [10,11]
The aim of the present study is to determine whether albumin, CRP and LDH levels are associated with the severity and course of ARDS in critically ill patients after new onset fever with or considered at risk for the syndrome defined by the Berlin and the LIS criteria
Summary
We studied the value of routine biochemical variables albumin, C-reactive protein (CRP) and lactate dehydrogenase (LDH) to improve prediction and monitoring of acute respiratory distress syndrome (ARDS) severity in the intensive care unit. The acute respiratory distress syndrome (ARDS) is caused by alveolocapillary inflammation and increased permeability following a direct pulmonary or extrapulmonary insult. Many conditions, such as sepsis and trauma, which increase the risk for developing or worsening of ARDS are associated with fever. The Berlin definition further includes preconditions and bilateral consolidations, even in the lowest class, while the lowest class of LIS may contain unilateral consolidation. Another limitation of these clinical classifications systems is their use of chest radiographs in the diagnostic work up. Clinicians may underdiagnose ARDS, when occurring late in the intensive care unit (ICU), and may be poorly able to quantify its severity and course, when clinical classification systems are not commonly used [4,6,7,8,14]
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