Elevated CXCL-8 expression in bronchoalveolar lavage correlates with disease severity in patients with acute respiratory distress syndrome resulting from tuberculosis.

Seyed Mohamad Reza Hashemian,Ali Akbar Velayati,Ian M Adcock,Gert Folkerts,Adnan Khosravi,Payam Tabarsi,Esmaeil Mortaz,Peter J Barnes,Mohamad Reza Masjedi,Hamidreza Jamaati,Zohreh Maghsoomi,Johan Garssen

doi:10.1186/1476-9255-11-21

Abstract

BackgroundTuberculosis (TB) is a rare but known cause of acute respiratory distress syndrome (ARDS). The role of inflammatory cytokines in the progression of ARDS in TB patients is unknown.ObjectivesIn this study we investigated the possible link between the levels of inflammatory cytokines in bronchoalveolar lavage (BAL) in patients with TB or ARDS alone or in patients with TB-induced ARDS (ARDS + TB).Methods90 patients were studied: 30 with TB alone, 30 with ARDS alone and 30 with ARDS + TB. BAL was collected by fiberoptic bronchoscopy and the concentrations of interleukin(IL)-6, CXCL8, TNF-α and IL-1β and the amounts of total protein were measured by ELISA and bicinchoninic acid assay (BCA) methods respectively. The correlation between disease severity measured by Murray scores, SOFA and APACHE II analysis and BAL mediators and cells was also determined.ResultsCXCL8 levels in BAL were significantly higher in the ARDS + TB group compared to TB and ARDS alone groups. Disease severity in the ARDS + TB group as determined by Murray score correlated with BAL CXCL8 and neutrophils but not with IL-6, IL-1β and TNF-α concentrations. In addition, CXCL8 levels and neutrophils were increased in non-miliary TB versus miliary TB. This difference in CXCL8 was lost in the presence of ARDS.ConclusionsBAL CXCL8 levels were significantly higher in patients with ARDS induced by TB and could suggest an important role of CXCL8 in the pathogenesis of this form of ARDS. This further suggests that CXCL8 inhibitors or blockers may be useful to control the onset and/or development of these combined diseases.

Highlights

Acute respiratory distress syndrome (ARDS) is a common disorder in the intensive care unit (ICU) and is associated with high mortality and morbidity [1]
bronchoalveolar lavage (BAL) CXCL8 levels were significantly higher in patients with acute respiratory distress syndrome (ARDS) induced by TB and could suggest an important role of CXCL8 in the pathogenesis of this form of ARDS
Inclusion criteria included patients in ICU with ARDS, TB or TB accompanied with ARDS [5,41]. 20 disease controls with a negative purified protein derivative (PPD) test were included in the study

Summary

Introduction

Acute respiratory distress syndrome (ARDS) is a common disorder in the intensive care unit (ICU) and is associated with high mortality and morbidity [1]. The common causes unusual cause of ARDS. ARDS is independently associated with mortality in TB patients in ICU [4] and is inversely associated with the treatment of underlying TB in those patients [5]. Factors contributing to the high mortality rate in ICU include consolidation on chest radiographs, multiple organ failure [6], high Acute Physiology and Chronic Health Evaluation (APACHE) II scores and sepsis [7]. Tuberculosis (TB) is a rare but known cause of acute respiratory distress syndrome (ARDS). The role of inflammatory cytokines in the progression of ARDS in TB patients is unknown

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