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Original Research: CRITICAL CARE |

Mucins Carrying Selectin Ligands as Predictive Biomarkers of Disseminated Intravascular Coagulation Complication in ARDS

Taku Nakashima, MD, PhD; Akihito Yokoyama, MD, PhD; Jyunya Inata, MD, PhD; Nobuhisa Ishikawa, MD, PhD; Yoshinori Haruta, MD, PhD; Noboru Hattori, MD, PhD; Nobuoki Kohno, MD, PhD, FCCP
Author and Funding Information

From the Department of Molecular and Internal Medicine (Drs Nakashima, Inata, Ishikawa, Haruta, Hattori, and Kohno), Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima; and the Department of Hematology and Respiratory Medicine (Dr Yokoyama), Kochi University, Kochi, Japan.

Correspondence to: Akihito Yokoyama, MD, PhD, Kochi University, Kohasu Oko-cho, Nankoku-city, Kochi 783-8505, Japan; e-mail: ayokoyama@kochi-u.ac.jp


Funding/support: This work was partially supported by Grants-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology of Japan.

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


© 2011 American College of Chest Physicians


Chest. 2011;139(2):296-304. doi:10.1378/chest.09-3082
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Background:  ARDS patients present with intrapulmonary and systemic coagulation abnormalities. We previously demonstrated that circulating KL-6/MUC1 could predict complications of disseminated intravascular coagulation (DIC) in ARDS. Recent studies indicate that circulating mucin can induce intravascular coagulation via interactions with selectin. We, therefore, investigated whether circulating mucins carrying selectin ligands are associated with DIC in ARDS.

Methods:  We evaluated newly diagnosed patients with ARDS (n = 46) or bacterial pneumonia (n = 17), and healthy control subjects (n = 60). Using serum collected at diagnosis, circulating levels of KL-6/MUC1, KL-6/MUC1 carrying sialyl Lewisa (SLAK), KL-6/MUC1 carrying sialyl Lewisx (SLXK), and P-selectin glycoprotein ligand-1 (PSGL-1) were measured.

Results:  Serum mucins with selectin ligands were significantly elevated in patients with ARDS compared with healthy control subjects. Significantly elevated levels of SLAK and SLXK were found in patients with ARDS subsequently complicated with DIC, as compared with those without DIC. In contrast, serum PSGL-1 levels were significantly decreased in ARDS patients with DIC. Furthermore, SLAK was discovered to be an independent predictor of DIC complication in ARDS. Using cutoff levels obtained by receiver operating characteristic curves, we found that these mucins can be used to distinguish between patients with ARDS with and without subsequently occurring DIC. Among the analyzed mucins, SLAK has the highest sensitivity and specificity for predicting future DIC development.

Conclusions:  These results suggest that mucins with selectin ligands are novel markers for ARDS with future complications of DIC, and KL-6/MUC1 carrying selectin ligands may be involved in the pathogenesis of DIC in patients with ARDS.

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