Abstract
BackgroundThe predictive role of many cytokines and adhesion molecules has not been studied systematically in acute respiratory distress syndrome (ARDS).MethodsWe measured prospectively tumour necrosis factor alpha (TNF-α), interleukin (IL)-1, soluble vascular adhesion molecule-1 (VCAM-1) and soluble intercellular adhesion molecule-1 (ICAM-1) in serum and bronchoalveolar lavage fluid (BALF) within 2 hours following admission, in 65 patients. The patients were divided into: those fulfilling the criteria for ARDS (n = 23, group A), those who were pre-ARDS and who developed ARDS within 24 hours (n = 14, group B), and those on pre-ARDS but who never developed ARDS (n = 28, group C).ResultsAll the measured molecules were only found at higher levels in the serum of patients that died either with or without ARDS (P < 0.05 – P < 0.0001). Patients at risk exhibited a good negative predictive value (NPV) of the measured molecules for ARDS development both in their serum (89 to 95%) and BALF (86 to 92%) levels. In contrast to BALF, serum levels of IL-1 and adhesion molecules exhibited a good NPV (68 to 96%), sensitivity (60 to 88%) and survival specificity (74 to 96%) in all groups. All molecules in serum and BALF IL-1 were correlated with the APACHE II (P < 0.05 – P < 0.0001). Serum and BALF IL-1 as well as BALF TNF-α were negatively correlated to PaO2/FiO2 (all P < 0.05).ConclusionsThe studied molecules have good NPV for ARDS development both in serum and BALF. Serum rather than BALF levels seem to be related to outcome.
Highlights
Acute respiratory distress syndrome (ARDS) is characterised during the early phase by diffuse inflammation and increased microvascular permeability that cause diffused interstitial and alveolar oedema and persistent refractory hypoxemia [1]
bronchoalveolar lavage fluid (BALF) TNF-α levels were higher in patients with acute respiratory distress syndrome (ARDS) than in patients at risk for ARDS and those who never developed ARDS (P < 0.0001 for both)
We investigated two categories of soluble molecules that might be involved in the pathogenesis of ARDS: proinflammatory cytokines and adhesion molecules
Summary
Acute respiratory distress syndrome (ARDS) is characterised during the early phase by diffuse inflammation and increased microvascular permeability that cause diffused interstitial and alveolar oedema and persistent refractory hypoxemia [1]. Various inflammatory mediators have been found to be increased in BALF in the early phase of ARDS, including endotoxin-binding proteins, tumour necrosis factor alpha (TNF-α), interleukin (IL)-1, IL-6, chemokines, adhesive molecules as well as matrix metalloproteinases and their inhibitors [2,3,4]. The predictive role of many cytokines and adhesion molecules has not been studied systematically in acute respiratory distress syndrome (ARDS). Methods: We measured prospectively tumour necrosis factor alpha (TNF-α), interleukin (IL)-1, soluble vascular adhesion molecule-1 (VCAM-1) and soluble intercellular adhesion molecule-1 (ICAM-1) in serum and bronchoalveolar lavage fluid (BALF) within 2 hours following admission, in 65 patients. Patients at risk exhibited a good negative predictive value (NPV) of the measured molecules for ARDS development both in their serum (89 to 95%) and BALF (86 to 92%) levels. Serum rather than BALF levels seem to be related to outcome
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