Abstract
Background: Procollagen peptides have been associated with lung fibroproliferation and poor outcomes in patients with acute respiratory distress syndrome (ARDS). Therefore, serum procollagen concentrations might have prognostic value in ARDS patients treated with extracorporeal membrane oxygenation (ECMO). Methods: In a prospective cohort study, serum N-terminal procollagen I-peptide (PINP) and N-terminal procollagen III-peptide (PIIINP) concentrations in twenty-three consecutive patients with severe ARDS treated with ECMO were measured at the time of ECMO initiation and during the course of treatment. The predictive value of PINP and PIIINP at the time of ECMO initiation was tested with a univariable logistic regression and a receiver operating characteristic (ROC) curve analysis. Results: Thirteen patients survived to intensive care unit (ICU) discharge. Non-survivors had higher serum PINP and PIIINP concentrations at all points in time during the course of treatment. Serum PIIINP at the day of ECMO initiation showed an odds ratio of 1.37 (95% CI 1.10–1.89, p = 0.017) with an area under the receiver operating characteristic (ROC) curve (AUC) of 0.87 (95% CI 0.69–1.00, p = 0.0029) for death during the course of treatment. Conclusions: PINP and PIIINP concentrations differ between survivors and non-survivors in ARDS treated with ECMO. This exploratory hypothesis generating study suggests an association between PIIINP serum concentrations at ECMO initiation and an unfavorable clinical outcome.
Highlights
High concentrations of procollagen III-peptide in serum and bronchoalveolar lavage fluid from acute respiratory distress syndrome (ARDS) patients have been associated with poor outcome [18,19,20,21,22,23] and elevated concentrations in bronchoalveolar fluid (BAL) during the early course of ARDS are associated with high mortality [22,23,24,25,26]
Twenty-three patients with severe ARDS treated with veno-venous extracorporeal membrane oxygenation (ECMO) were included in the study
As we describe a correlation between higher PIIINP and worse outcomes, and not a causality per se, we cannot differentiate whether elevated PIIINP is associated with injurious ventilation, inflammatory affection of the lungs or a deleterious combination of both factors
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. For the most severe cases of ARDS, extracorporeal membrane oxygenation (ECMO) is a treatment option to guarantee oxygenation and facilitate lung protective ventilation [6,7,8]. High concentrations of procollagen III-peptide in serum and bronchoalveolar lavage fluid from ARDS patients have been associated with poor outcome [18,19,20,21,22,23] and elevated concentrations in bronchoalveolar fluid (BAL) during the early course of ARDS are associated with high mortality [22,23,24,25,26].
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