Abstract
The use of biomarkers in medicine lies in their ability to detect disease and support diagnostic and therapeutic decisions. New research and novel understanding of the molecular basis of the disease reveals an abundance of exciting new biomarkers who present a promise for use in the everyday clinical practice. The past fifteen years have seen the emergence of numerous clinical applications of several new molecules as biologic markers in the research field relevant to acute respiratory distress syndrome (translational research). The scope of this review is to summarize the current state of knowledge about serum biomarkers in acute lung injury and acute respiratory distress syndrome and their potential value as prognostic tools and present some of the future perspectives and challenges.
Highlights
The use of biomarkers in medicine lies in their ability to detect disease and support diagnostic and therapeutic decisions
Their bronchoalveolar lavage fluid (BALF) levels have been found elevated in patients with acute respiratory distress syndrome (ARDS) and their involvement in the alterations of microvascular permeability correlated with the accumulation of pulmonary oedema has been suggested [61,62,63]
On the contrary the majority of serum cytokines and ferritin appear to be not ready for routine monitoring since they may reflect an inflammatory response to a risk factor rather than lung injury and disease severity
Summary
The use of biomarkers in medicine lies in their ability to detect disease and support diagnostic and therapeutic decisions. A large variety of inflammatory mediators (Table 1) have been found to be elevated in the early phase of ARDS, including lungspecific proteins, endotoxin binding proteins, tumor necrosis-alpha (TNFa), interleukins – (ILs) – 1, 2, 6, 8, 15, chemokines, ferritin, markers of endothelium activation (adhesive molecules and von-Willebrand factor antigenVWF) as well as markers of neutrophil activation such as matrix metalloproteinases (MMPs) and their inhibitors and leukotrienes [5,6,7]. From a practical point of view, a clinical useful biomarker for ARDS must add information regarding the development of syndrome in at-risk patients that is not apparent from routine examination and investigation. The latter, could help the intensivist to monitor the disease and evaluate or modulate treatments before they have failed. Driven by this perspective idea, many studies have estimated their usefulness as early predictors of ARDS and accurate markers of lung injury before clinical changes can be detected
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