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Serum Concentrations of Surfactant Proteins A and D Predict Mortality in Patients With Idiopathic Pulmonary Fibrosis* FREE TO VIEW

Kelly E. Greene, MD; Y. Kuroki, MD; B. Bucher Bartelson, PhD; T. E. King, MD, FCCP; G. W. Hunninghake, MD, FCCP; P. E. Parsons, MD; L. S. Newman, MD, FCCP; H. Nagoe; R. Tudor; C. Kuhn, MD; R. J. Mason, MD
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*From the Departments of Medicine, Biostatistics, Pathology, and Occupational Medicine, National Jewish Medical and Research Center, Denver, CO; the Department of Medicine, University of Iowa College of Medicine, Iowa City, IA; and Sapporo Medical University, Sapporo, Japan.

Correspondence to: Kelly E. Greene, MD, Assistant Professor of Medicine, Division of Pulmonary Medicine, National Jewish Medical Center, University of Colorado Health Sciences Center, 1400 Jackson St, Denver, CO 80206

Chest. 2001;120(1_suppl):S72. doi:10.1378/chest.120.1_suppl.S72
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Idiopathic pulmonary fibrosis (IPF) has a high mortality rate, and current therapy is only marginally effective. A serum biomarker that predicts clinical outcome would be useful to stage disease, indicate prognosis and need for aggressive therapy, and help stratify patients for clinical trials. The goal of this study was to evaluate serum levels of surfactant protein (SP)-A and SP-D in two large cohorts of patients with IPF and compare them to serum levels from normal control subjects and patients with other lung diseases. In addition, we wanted to determine if serum levels of SP-A or SP-D predict survival in patients with IPF. We demonstrated that serum SP-A levels are significantly elevated in patients with IPF (92.7 ng/mL) and ARDS (61.0 ng/mL) compared to levels in normal subjects (39.6 ng/mL; p = 0.0001) and those with the other pulmonary diseases studied. We also demonstrated significantly elevated serum SP-D levels in patients with IPF (392.3 ng/mL) and ARDS (300.0 ng/mL) compared to levels in normal subjects (98.0 g/mL; p = 0.0001). Serum levels of both SP-A and SP-D obtained at the time of initial evaluation predict survival in patients with IPF (hazards ratio ln(SP-A) = 1.73; p = 0.031 and hazards ratio ln(SP-D) = 2.04; p = 0.003). Serum SP-D appears to correlate better than SP-A with the extent of disease in patients with IPF and is related to abnormal radiographic findings in patients with sarcoidosis and chronic beryllium disease. The mechanism(s) by which SP-A and SP-D enter the serum and the value of measuring SP-A and SP-D during therapeutic trials remain to be elucidated.

Abbreviations: IPF = idiopathic pulmonary fibrosis; SP = surfactant protein




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