Abstract
BackgroundOxidative stress plays an important role in acute lung injury, which is associated with the development and progression of acute respiratory failure. Here, we investigated whether the degree of oxidative stress as indicated by serum heme oxygenase-1 (HO-1) is clinically useful for predicting prognosis among the patients with acute respiratory distress syndrome (ARDS) and acute exacerbation of interstitial lung disease (AE-ILD).MethodsSerum HO-1 levels of newly diagnosed or untreated ARDS and AE-ILD patients were measured at diagnosis. Relationships between serum HO-1 and other clinical parameters and 1 and 3-month mortality were evaluated.ResultsFifty-five patients including 22 of ARDS and 33 of AE-ILD were assessed. Serum HO-1 level at diagnosis was significantly higher in ARDS patients than AE-ILD patients (87.8 ± 60.0 ng/mL vs. 52.5 ± 36.3 ng/mL, P < 0.001). Serum HO-1 correlated with serum total bilirubin (R = 0.454, P < 0.001) and serum LDH (R = 0.500, P < 0.001). In both patients with ARDS and AE-ILDs, serum HO-1 level tended to decrease from diagnosis to 2 weeks after diagnosis, however, did not normalized. Composite parameters including serum HO-1, age, sex, and partial pressure of oxygen in arterial blood/fraction of inspired oxygen (P/F) ratio for prediction of 3-month mortality showed a higher AUC (ARDS: 0.925, AE-ILDs: 0.892) than did AUCs of a single predictor or combination of two or three predictors.ConclusionOxidative stress assessed by serum HO-1 is persistently high among enrolled patients for 2 weeks after diagnosis. Also, serum HO-1 levels at the diagnosis combined with age, sex, and P/F ratio could be clinically useful for predicting 3-month mortality in both ARDS and AE-ILD patients.
Highlights
Acute respiratory distress syndrome (ARDS) is one of the major manifestations of multiple organ failure syndrome and is a leading cause of death in intensive care units [1]
We have demonstrated the usefulness of measuring serum heme oxygenase-1 (HO-1) in the diagnosis and prognosis of patients with acute respiratory distress syndrome (ARDS) and acute exacerbation (AE)-interstitial lung disease (ILD) [19, 20]
We investigated whether the degree of oxidative stress measured by serum HO-1 levels at the diagnosis could be useful for predicting prognosis and these levels could decrease during the clinical courses among patients with ARDS and acute exacerbation of interstitial lung disease (AE-ILD)
Summary
Acute respiratory distress syndrome (ARDS) is one of the major manifestations of multiple organ failure syndrome and is a leading cause of death in intensive care units [1]. Several clinical evidences suggested that increased oxidative/nitrosative stress might play a major role in the progression of various lung diseases such as idiopathic pulmonary fibrosis (IPF), chronic obstructive pulmonary disease, and ARDS [9,10,11,12,13,14]. HO-1 catalyzes heme degradation to biliverdin-IXα, carbon monoxide, and iron These metabolites mediate the antiapoptotic, anti-inflammatory, vasodilatory, anticoagulant, antioxidant, and antiproliferative properties of HO-1 under the control of the microsomal nicotinamide adenine dinucleotide phosphate-cytochrome p450 reductase [15, 16]. We investigated whether the degree of oxidative stress as indicated by serum heme oxygenase-1 (HO-1) is clinically useful for predicting prognosis among the patients with acute respiratory distress syndrome (ARDS) and acute exacerbation of interstitial lung disease (AE-ILD)
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