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Original Research: CRITICAL CARE |

Pre-B-Cell Colony-Enhancing Factor and Its Clinical Correlates With Acute Lung Injury and SepsisPlasma Pre-B-Cell Colony-Enhancing Factor

Kathleen A. Lee, MD; Michelle N. Gong, MD
Author and Funding Information

From the Department of Medicine (Dr Lee), Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI; and the Division of Critical Care Medicine (Dr Gong), Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.

Correspondence to: Michelle N. Gong, MD, Division of Critical Care Medicine, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467; e-mail: MGong@montefiore.org


Funding/Support: Supported by a Doris Duke Clinical Research Fellowship for Medical Students and the National Heart, Lung, and Blood Institute [Grants HL60197, HL084060, and HL086667].

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;140(2):382-390. doi:10.1378/chest.10-3100
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Background:  Pre-B-cell colony-enhancing factor (PBEF) is a potential biomarker for acute lung injury (ALI) in sepsis. We aimed to determine the clinical correlates for elevated plasma PBEF upon ICU admission for severe sepsis and the usefulness of PBEF to predict ALI development and sepsis mortality.

Methods:  This is a prospective cohort of patients admitted to the medical ICU with severe sepsis. Patients without available blood samples or who were not enrolled within 24 h of admission were excluded. Plasma collected within 24 h of ICU admission was measured for PBEF concentrations by enzyme-linked immunosorbent assay. Patients were followed for ALI development as defined by the American-European Consensus Conference and for all-cause hospital mortality.

Results:  Between September 30, 2008, and March 10, 2009, 113 patients were enrolled, and 50 (44%) developed ALI. Elevated PBEF levels significantly correlated with higher APACHE (Acute Physiology and Chronic Health Evaluation) III scores (R2 = 0.08, P = .003) and failure to reach early sepsis goals within 6 h of severe sepsis (P = .003). PBEF did not differ by ALI status (P = .58). The mortality rate was 46%. Nonsurvivors had higher PBEF levels than survivors (2.53 ng/mL; interquartile range [IQR], 1.07-8.16 vs 1.44 ng/mL; IQR, 0.84-2.81; P = .02). After adjusting for severity of illness, PBEF levels were no longer significantly associated with mortality (OR, 1.44 per 10-fold increase; 95% CI, 0.69-3.03, P = .34).

Conclusions:  In this study, elevated PBEF did not correlate with lung injury in sepsis. However, it was associated with sepsis mortality mainly due to its association with greater severity of illness on ICU admission.

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