Acute lung injury in patients with traumatic injuries: utility of a panel of biomarkers for diagnosis and pathogenesis.

BACKGROUND The diagnosis of acute lung injury (ALI) is based on a consensus clinical definition. Despite the simplicity of this definition, ALI remains underdiagnosed and undertreated. Severe trauma is a well-described cause of ALI that represents a relatively homogeneous subset of patients with ALI. The aims of this study were to develop a panel of plasma biomarkers to facilitate diagnosis of trauma-induced ALI and to enhance our understanding of the pathogenesis of human ALI. METHODS A retrospective nested case control of 192 patients admitted to the trauma intensive care unit at a university hospital between 2002 and 2006. We compared 107 patients with ALI to 85 patients without ALI. Plasma was collected within 72 hours of intensive care unit admission. Twenty-one plasma biomarkers were measured in duplicate in each plasma sample. RESULTS Patients with ALI had higher severity of illness scores, more days of mechanical ventilation, longer hospital stays, and higher mortality versus controls. Seven biomarkers (receptor for advanced glycation end products, procollagen peptide III, brain natriuretic peptide, angiopoietin-2, interleukin-10, tumor necrosis factor alpha, and interleukin-8) had a high diagnostic accuracy as reflected by the area under the receiver operating characteristic curve of 0.86 (95% confidence interval, 0.82-0.92) in differentiating ALI from controls. CONCLUSIONS A model using seven plasma biomarkers had a high diagnostic accuracy in differentiating patients with trauma-induced ALI from trauma patients without ALI. In addition, use of a panel of biomarkers provides insight into the likely importance of alveolar epithelial injury in the pathogenesis of early ALI.

[1]  Lesly A. Dossett,et al.  Obesity and pulmonary complications in critically injured adults. , 2008, Chest.

[2]  P. Parsons,et al.  Plasma receptor for advanced glycation end products and clinical outcomes in acute lung injury , 2008, Thorax.

[3]  M. Matthay,et al.  Biomarkers of inflammation, coagulation and fibrinolysis predict mortality in acute lung injury , 2008, Critical care.

[4]  Lesly A. Dossett,et al.  High levels of endogenous estrogens are associated with death in the critically injured adult. , 2008, The Journal of trauma.

[5]  Lesly A. Dossett,et al.  Serum estradiol concentration as a predictor of death in critically ill and injured adults. , 2008, Surgical infections.

[6]  Patrick R. Norris,et al.  Estradiol is associated with mortality in critically ill trauma and surgical patients , 2008, Critical care medicine.

[7]  P. Rhee,et al.  The presence of the adult respiratory distress syndrome does not worsen mortality or discharge disability in blunt trauma patients with severe traumatic brain injury. , 2008, Injury.

[8]  P. Parsons,et al.  Trauma-associated lung injury differs clinically and biologically from acute lung injury due to other clinical disorders* , 2007, Critical care medicine.

[9]  M. Kenward,et al.  An Introduction to the Bootstrap , 2007 .

[10]  Gordon R Bernard,et al.  Comparison of two fluid-management strategies in acute lung injury. , 2006, The New England journal of medicine.

[11]  H. Belzberg,et al.  Acute respiratory distress syndrome in the trauma intensive care unit: Morbid but not mortal. , 2006, Archives of surgery.

[12]  M. Matthay,et al.  Receptor for advanced glycation end-products is a marker of type I cell injury in acute lung injury. , 2006, American journal of respiratory and critical care medicine.

[13]  C. Sprung,et al.  Sepsis in European intensive care units: Results of the SOAP study* , 2006, Critical care medicine.

[14]  Diane P. Martin,et al.  Incidence and outcomes of acute lung injury. , 2005, The New England journal of medicine.

[15]  G. Zimmerman,et al.  Acute lung injury and the acute respiratory distress syndrome: four decades of inquiry into pathogenesis and rational management. , 2005, American journal of respiratory cell and molecular biology.

[16]  G. Rubenfeld,et al.  Causes and timing of death in patients with ARDS. , 2005, Chest.

[17]  M. Matthay,et al.  Clinical practice. Acute pulmonary edema. , 2005, The New England journal of medicine.

[18]  P. Parsons,et al.  Significance of von Willebrand factor in septic and nonseptic patients with acute lung injury. , 2004, American journal of respiratory and critical care medicine.

[19]  D. Morabito,et al.  Acute respiratory distress syndrome criteria in trauma patients: why the definitions do not work. , 2004, The Journal of trauma.

[20]  Diane P. Martin,et al.  Effect of acute lung injury and acute respiratory distress syndrome on outcome in critically ill trauma patients* , 2004, Critical care medicine.

[21]  P. Parsons,et al.  Plasma surfactant protein levels and clinical outcomes in patients with acute lung injury , 2003, Thorax.

[22]  M. Matthay,et al.  Elevated levels of plasminogen activator inhibitor-1 in pulmonary edema fluid are associated with mortality in acute lung injury. , 2003, American journal of physiology. Lung cellular and molecular physiology.

[23]  C. Goss,et al.  Incidence of acute lung injury in the United States. , 2003, Critical care medicine.

[24]  Sunil J Rao,et al.  Regression Modeling Strategies: With Applications to Linear Models, Logistic Regression, and Survival Analysis , 2003 .

[25]  Arnaldo Dubin,et al.  Incidence, clinical course, and outcome in 217 patients with acute respiratory distress syndrome , 2002, Critical care medicine.

[26]  G. Zimmerman,et al.  Fas and fas ligand are up-regulated in pulmonary edema fluid and lung tissue of patients with acute lung injury and the acute respiratory distress syndrome. , 2002, The American journal of pathology.

[27]  E. Ely,et al.  Using the chest radiograph to determine intravascular volume status: the role of vascular pedicle width. , 2002, Chest.

[28]  K. Jones,et al.  Low tidal volume reduces epithelial and endothelial injury in acid-injured rat lungs. , 2002, American journal of respiratory and critical care medicine.

[29]  H. Folkesson,et al.  Lung epithelial fluid transport and the resolution of pulmonary edema. , 2002, Physiological reviews.

[30]  G. Evans,et al.  Radiologic determination of intravascular volume status using portable, digital chest radiography: A prospective investigation in 100 patients , 2001, Critical care medicine.

[31]  D. Schoenfeld,et al.  Efficacy of low tidal volume ventilation in patients with different clinical risk factors for acute lung injury and the acute respiratory distress syndrome. , 2001, American journal of respiratory and critical care medicine.

[32]  Theodore Speroff,et al.  Evaluation of delirium in critically ill patients: Validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) , 2001, Critical care medicine.

[33]  M. Matthay,et al.  Alveolar fluid clearance is impaired in the majority of patients with acute lung injury and the acute respiratory distress syndrome. , 2001, American journal of respiratory and critical care medicine.

[34]  N. Goldsack,et al.  Fibroproliferation occurs early in the acute respiratory distress syndrome and impacts on outcome. , 2000, American journal of respiratory and critical care medicine.

[35]  D. Schoenfeld,et al.  Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. , 2000, The New England journal of medicine.

[36]  M. Matthay,et al.  The acute respiratory distress syndrome. , 1996, The New England journal of medicine.

[37]  J. Whitsett,et al.  Serial changes in surfactant-associated proteins in lung and serum before and after onset of ARDS. , 1999, American journal of respiratory and critical care medicine.

[38]  J. Pittet,et al.  α-Adrenergic blockade restores normal fluid transport capacity of alveolar epithelium after hemorrhagic shock. , 1999, American journal of physiology. Lung cellular and molecular physiology.

[39]  J. Pittet,et al.  Inhibition of beta-adrenergic-dependent alveolar epithelial clearance by oxidant mechanisms after hemorrhagic shock. , 1999, The American journal of physiology.

[40]  J. Pittet,et al.  Inhibition of β-adrenergic-dependent alveolar epithelial clearance by oxidant mechanisms after hemorrhagic shock. , 1999, American journal of physiology. Lung cellular and molecular physiology.

[41]  J. Pittet,et al.  alpha-adrenergic blockade restores normal fluid transport capacity of alveolar epithelium after hemorrhagic shock. , 1999, The American journal of physiology.

[42]  F. Stentz,et al.  Procollagen types I and III aminoterminal propeptide levels during acute respiratory distress syndrome and in response to methylprednisolone treatment. , 1998, American journal of respiratory and critical care medicine.

[43]  K. Weber,et al.  Extracellular matrix remodeling in heart failure: a role for de novo angiotensin II generation. , 1997, Circulation.

[44]  Weber Kt.  Monitoring tissue repair and fibrosis from a distance. , 1997 .

[45]  S. Cohn,et al.  Pulmonary contusion: review of the clinical entity. , 1997, The Journal of trauma.

[46]  K. Weber.  Monitoring tissue repair and fibrosis from a distance. , 1997, Circulation.

[47]  M. Matthay,et al.  Early detection of type III procollagen peptide in acute lung injury. Pathogenetic and prognostic significance. , 1997, American journal of respiratory and critical care medicine.

[48]  R. Maunder,et al.  Clinical risks for development of the acute respiratory distress syndrome. , 1995, American journal of respiratory and critical care medicine.

[49]  K. Steinberg,et al.  Type III Procollagen Peptide in the Adult Respiratory Distress Syndrome: Association of Increased Peptide Levels in Bronchoalveolar Lavage Fluid with Increased Risk for Death , 1995, Annals of Internal Medicine.

[50]  M. Lamy,et al.  The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. , 1994, American journal of respiratory and critical care medicine.

[51]  R. Tibshirani,et al.  An Introduction to the Bootstrap , 1995 .

[52]  C. Waydhas,et al.  Increased serum concentrations of procollagen type III peptide in severely injured patients: An indicator of fibrosing activity? , 1993, Critical care medicine.

[53]  P. Vacek,et al.  Serum and bronchoalveolar lavage of N-terminal type III procollagen peptides in idiopathic pulmonary fibrosis. , 1992, The American review of respiratory disease.

[54]  W. Knaus,et al.  The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. , 1991, Chest.

[55]  P. Rogol.  Intact epithelial barrier function is critical for resolution of alveolar edema in humans. , 1991, The American review of respiratory disease.

[56]  D. Green,et al.  Elevated von Willebrand factor antigen is an early plasma predictor of acute lung injury in nonpulmonary sepsis syndrome. , 1990, The Journal of clinical investigation.

[57]  W. Copes,et al.  Evaluating trauma care: the TRISS method. Trauma Score and the Injury Severity Score. , 1987, The Journal of trauma.

[58]  M. Pistolesi,et al.  The vascular pedicle of the heart and the vena azygos. Part II: Acquired heart disease. , 1984, Radiology.

[59]  M. Pistolesi,et al.  The vascular pedicle of the heart and the vena azygos. Part I: The normal subject. , 1984, Radiology.

[60]  B. Kommerell,et al.  Biliary excretion of procollagen type III peptide in healthy humans and in patients with alcoholic cirrhosis of the liver. , 1983, Gastroenterology.

[61]  K. Cutroneo,et al.  Lavage type III procollagen N-terminal peptides in human pulmonary fibrosis and sarcoidosis. , 1983, Laboratory investigation; a journal of technical methods and pathology.

[62]  E. Weibel,et al.  Alterations of the gas exchange apparatus in adult respiratory insufficiency associated with septicemia. , 2015, The American review of respiratory disease.

[63]  S. Baker,et al.  The injury severity score: an update. , 1976, The Journal of trauma.

[64]  W. Haddon,et al.  The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. , 1974, The Journal of trauma.

[65]  M. Matthay,et al.  Acute Pulmonary Edema , 2005 .