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Original Research: CRITICAL CARE MEDICINE |

The Association Between BMI and Plasma Cytokine Levels in Patients With Acute Lung Injury

Renee D. Stapleton, MD, FCCP; Anne E. Dixon, MD, FCCP; Polly E. Parsons, MD, FCCP; Lorraine B. Ware, MD, FCCP; Benjamin T. Suratt, MD, FCCP; the NHLBI Acute Respiratory Distress Syndrome Network
Author and Funding Information

From the Department of Medicine, Division of Pulmonary and Critical Care Medicine (Drs Stapleton, Dixon, Parsons, and Suratt) University of Vermont College of Medicine, Burlington, VT; and the Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine (Dr Ware), Vanderbilt University, Nashville, TN.

Correspondence to: Renee D. Stapleton, MD, FCCP, University of Vermont College of Medicine, HSRF 222, 149 Beaumont Ave, Burlington, VT 05405; e-mail: renee.stapleton@uvm.edu


Funding/Support: This research was partially supported by the National Institutes of Health [Grants HL084200, P20 RR015557, HL081332, and NO1HR46064].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(3):568-577. doi:10.1378/chest.10-0014
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Background:  Obesity is associated with poor outcomes in many diseases, although recent data suggest that acute lung injury (ALI) is an exception. This is particularly interesting because obesity is marked by increased levels of proinflammatory mediators associated with increased morbidity and mortality in ALI. We hypothesized that cytokine response might be attenuated in patients who are obese and critically ill or that obesity might modify the relationship between plasma cytokines and clinical outcomes in ALI.

Methods:  We analyzed plasma biomarker levels (interleukin [IL]-6, IL-8, tumor necrosis factor-α receptor 1, surfactant protein D [SP-D], soluble intracellular adhesion molecule, von Willebrand factor (vWF), protein C, and plasminogen activator inhibitor-1) collected at baseline and day 3 in 1,409 participants in prior National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Network (ARDSNet) trials. BMI was calculated for each patient, and associations with cytokine levels and ventilator-free days (VFDs), organ failure-free days (OFDs), and mortality were investigated in regression models adjusting for confounders.

Results:  In adjusted analyses, plasma IL-6 (P = .052), IL-8 (P = .001), and SP-D (P < .001) were inversely related to BMI, whereas vWF (P = .001) and WBC count (P = .042) increased proportionally with BMI. BMI was not associated with increased morbidity or mortality and did not modify the association between baseline biomarker levels and mortality, VFDs, or OFDs.

Conclusions:  Patients who are obese and have ALI have lower levels of several proinflammatory cytokines, suggesting that the inflammatory response may be altered in patients with ALI and a high BMI. Lower SP-D but higher vWF suggests decreased epithelial and increased endothelial injury in the lung of patients who are obese. Mechanisms by which obesity may modulate innate immunity in critical illness are unclear, and future studies should elucidate such mechanisms.

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