PURPOSE:Several studies have found multiple biomarkers to be associated with increased mortality. However, most studies were performed before the implementation of recent advances in mechanical ventilation and supportive care and/or in the context of clinical trials with restricted inclusion criteria. We measured plasma markers of epithelial damage, endothelial damage, inflammation, and coagulation simultaneously to assess whether these markers remain predictive of in-hospital mortality in the era of lung-protective ventilation.
METHODS:Ninety six consecutive critically ill patients >18 years of age admitted to three ICUs at Mayo Clinic, MN, that met the criteria for ALI/ARDS were included in the study. Demographic data, Acute Physiology and Chronic Health Evaluation (APACHE) III scores, plasma samples and ventilator data were prospectively collected. Plasma biomarkers of inflammation (Interleukin 8 [IL-8]), epithelial damage (Clara cell protein 16 and Receptor for advanced glycation end-products [RAGE]), endothelial damage (von Willebrand Factor [vWF]), and coagulation (Thrombin-antithrombin III complex [TAT-III]) were measured by ELISA at the time of diagnosis. Comparison between survivors and non-survivors were made utilizing Wilcoxon test for the univariate analysis, and logistic regression analysis for the multivariate analysis, after adjustment for APACHE III predicted mortality and PaO2/FiO2 ratio.
RESULTS:Median age (IQR) was 62.5 years (51–74), 54 patients were male (56%). Seventy four patients survived to hospital discharge (77%). The table below describes the median biomarkers levels at the time of diagnosis in survivors as compared to non-survivors. Only IL-8 showed higher significant levels in non-survivors in the univariate analysis as compared to survivors, however, after multivariate analysis; none of the biomarkers showed significant differences in survivors versus non-survivors.
CONCLUSION:After adjusting for predicted hospital mortality and severity of ALI/ARDS; no differences in the levels of markers of coagulation, endothelial and epithelial damage were found between survivors and no survivors of ALI/ARDS in the era of lung protective ventilation.
CLINICAL IMPLICATIONS:Biomarkers of inflammation,coagulation,epithelial damage,and endothelial damage have no predictive role of in-hospital mortality in the era of lung protective ventilation.
DISCLOSURE:Rodrigo Cartin-Ceba, No Financial Disclosure Information; No Product/Research Disclosure Information