Abstract
BackgroundContradictory results regarding changes in serum club cell protein 16 (CC16) levels in patients with acute respiratory distress syndrome (ARDS) have been reported, challenging the value of CC16 as a diagnostic and prognostic marker for ARDS. We have also observed increased serum CC16 levels in patients with renal dysfunction (RD). Therefore, the present study aimed to determine whether RD affects the diagnostic performance of CC16 for ARDS in intensive care unit (ICU) patients.MethodsWe measured serum CC16 concentrations in 479 ICU patients, who were categorized into six groups according to their diagnoses: control, acute kidney injury (AKI), chronic kidney disease (CKD), ARDS, ARDS+AKI, and ARDS+CKD. The sensitivity, specificity, and cutoff values for serum CC16 were assessed by receiver operating characteristic curve analysis.ResultsSerum CC16 concentrations were higher in the ARDS group than in the control group, and in ARDS patients with normal renal function, serum CC16 could identify ARDS and predict survival outcomes at 7 and 28 days. However, serum CC16 levels were similar among the ARDS+AKI, ARDS+CKD, AIK, and CKD groups. Consequently, in patients with AKI and/or CKD, the specificity of CC16 for diagnosing ARDS or ARDS+RD decreased from 86.62 to 2.82% or 81.70 to 2.12%, respectively. Consistently, the CC16 cutoff value of 11.57 ng/ml in patients with RD differed from the established values of 32.77–33.72 ng/ml with normal renal function. Moreover, the predictive value of CC16 for mortality in ARDS+RD patients was lost before 7 days but regained by 28 days.ConclusionRD reduces the diagnostic specificity, diagnostic cutoff value, and predictive value for 7-day mortality of serum CC16 for ARDS among ICU patients.
Highlights
Contradictory results regarding changes in serum club cell protein 16 (CC16) levels in patients with acute respiratory distress syndrome (ARDS) have been reported, challenging the value of CC16 as a diagnostic and prognostic marker for ARDS
Higher blood pressure and a higher proportion of cardiogenic pulmonary edema were observed in the chronic kidney disease (CKD) and ARDS+CKD groups compared with the control group (Table 1)
Even higher serum CC16 concentrations were observed in the following groups, with no significant differences among these groups: ARDS+acute kidney injury (AKI) group (64.89 ± 20.47 ng/ml), ARDS+CKD group (72.21 ± 18.63 ng/ml), AKI group (59.77 ± 26.76 ng/ml), and CKD group (62.77 ± 25.11 ng/ml) (Fig. 1)
Summary
Contradictory results regarding changes in serum club cell protein 16 (CC16) levels in patients with acute respiratory distress syndrome (ARDS) have been reported, challenging the value of CC16 as a diagnostic and prognostic marker for ARDS. The present study aimed to determine whether RD affects the diagnostic performance of CC16 for ARDS in intensive care unit (ICU) patients. Acute respiratory distress syndrome (ARDS) is an acute lung disease with high mortality and morbidity in intensive care units (ICUs). More than 20 potential biomarkers have been explored for their potential value in the diagnosis and prediction of ARDS in current studies [1], including the club cell protein (CC16). CC16, as the most abundant secretory protein found in the surface fluids of the airways, plays an important role in the maintenance and repair of lung airways [4]. CC16 was reported as a potential biomarker of pulmonary injury caused by inhaled ozone, chlorine, and lipopolysaccharide (LPS) [2]
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