Study on relationship between extravascular lung water, TNF-a, E-selectin, vasostatin-2 and the prognosis of patients with ARDS

Abstract

Objective To analyze the correlations between acute respiratory distress syndrome （ ARDS） and extravascular lung water（EVLW）,tumor necrosis factor alpha （TNF-α）,E-selectin,vasostatin-2.To discuss the value of EVLW, TNF-α, E-selectin and vasostatin-2 in evaluating the severity of ARDS and prognosis of this disease . Methods There are thirty-six patients with ARDS were selected .According to the level of EVLWI shown by pulse indicator continuous cardiac output （ PiCCO） monitor,they were divided into the two groups：EVLWI≥14mL/kg group （n=18） and EVLWI〈14mL/kg group（n=18）.To monitor and record the levels of EVLWI ,PVPI,CI,ITBV,record oxygenation index ,calculate APACHEII score .The levels of TNF-α,E-selectin and vasostatin-2 in serum were meas-ured by ELISA.Results In EVLWI≥14mL/kg group,the APACHEⅡscore was （23.93 ±4.44）,28-day mortality was 61.1%,the stay time in ICU was （19.05 ±4.0） d,which were higher than those in EVLWI 〈14mL/kg group [APACHEII score （18.58 ±3.66）,28-day mortality（27.8%）,the stay time in ICU（14.35 ±3.39） d]（t=3.941,χ2 =4.050,t=3.797,all P〈0.01）.And the levels of TNF-α[（85.28 ±18.25）μg/L]and E-selectin[（74.07 ± 14.57）μg/L]in serum were higher than in EVLWI 〈14mL/kg group[TNF-α（63.27 ±20.28）μg/L,E-selectin （40.99 ±16.35）μg/L]（t=3.422,5.847,all P〈0.01）.The oxygenation index of EVLWI≥14mL/kg group was （122.86 ±25.45）,which was lower than that in EVLWI 〈14mL/kg group[（156.77 ±37.58）]（t=-3.170,P〈0.01）.In the two groups of patients still alive within 28 days,after active treatment for 72 hours,the level of EVLWI was significantly lower than before in these 20 patients（Z=-0.392,P〈0.01）,oxygenation index was significantly higher than before（Z=-3.845,P〈0.01）,and the levels of TNF-αand E-selectin were significantly lower than before（t=7.194,4.025,all P〈0.01）.But 16 patients in the death group,after active treatment for 72 hours,the levels of EVLWI ,TNF-α,E-selectin and oxygenation index had no significant change ,there was no statistically signifi-cant difference（P〉0.05）.EVLWI had positive correlation with PVPI,TNF-αand E-selectin （r=0.605,0.649, 0.549,all P〈0.01）,and EVLWI had a negative correlation with oxygenation index （r=-0.715,P〈0.01）.Results showed no difference in vasostatin-2 between the two groups（P〉0.05）.Conclusion There were significant correla-tions between EVLWI and TNF-α,E-selectin in patients with ARDS.The levels of EVLWI,TNF-α,E-selectin were higher,and the mortality rate was higher,the the stay time in ICU was longer.The levels of EVLWI,TNF-αand E-selectin can provide a good reference value to the judgement of the severity of disease and prognosis in patients with ARDS.The level of vasostatin-2 had no correlation with EVLWI . Key words: Extravascular lung water; Tumor necrosis factor alpha; E-selectin; Angiostatins ; Respiratory distress syndrome, adult