Critical Care |

Plasma ST2 Predicts Mortality in Patients With Acute Respiratory Distress Syndrome FREE TO VIEW

Marina García de Acilu, MD; Oriol Roca, PhD; Joan Ramon Masclans, PhD; Laura Ruano, BS; Jordi Rello, PhD
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Vall d Hebron University Hospital, CibeRes, Barcelona, Spain

Chest. 2014;145(3_MeetingAbstracts):174A. doi:10.1378/chest.1822406
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SESSION TITLE: ARDS/Lung Injury Posters

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: The aim of this study was to examine the value of measurement of the interleukin-33 (IL-33) and ST2 in patients with ARDS.

METHODS: It is a single-centre prospective cohort observational study, including patients with ARDS who required ICU admission. Plasma concentrations of IL-33 and ST2 at day 1 and 3 of ARDS onset were determined. Differences in concentration of IL-33 and ST2 were determined using ANOVA for repeated measures. Discrimination of significant variables was tested by calculating the area of receiver operating characteristic curve (AUROC). Survival curves were compared using the log-rank test. To identify which variables at admission were associated with ICU mortality multivariate Cox proportional hazard regression models were used.

RESULTS: Seventeen ARDS patients (12 [70.6%] male) with a median age of 61 (interquartile range [IQR] 48-70) yo were included. Median APACHE II was 24 (19-29) and origin of ARDS was intrapulmonary in 12 (70.6%) patients. At day 1, 12 (70.6%) patients were MV and 5 (29.4%) were treated with high flow nasal cannula. ICU mortality was 41.2%. Median concentrations of ST-2 at day 1 (4934 [IQR 3672-7547]pg/ml vs 1007 [IQR 677-1987]pg/ml) and at day 3 (5720 [IQR 3932-7404]pg/ml vs 823 [IQR 597-1547]pg/ml) were higher among ICU non-survivors than survivors (p<0.001). No significant differences in IL-33 concentrations were observed. ST2 concentration at day 1 accurately identified patients who died (AUROC 0.96 [95%CI 0.86-1.0]; p<0.01) and outperformed APACHE and SOFA. ST2 concentration at day 1 ≥ 3672pg/ml identified patients who died with 86% sensitivity and 100% specificity. A Kaplan-Meier survival curve showed higher survival in patients with concentration of ST2<3672 at day 1 of ARDS onset (p<0.001). In the multivariate analysis, the only variable associated with ICU mortality was ST2≥3672 at day 1 (HR 14.7 [95%CI 1.7-131.1]).

CONCLUSIONS: In this pilot study, ST2 concentrations are associated with higher ICU mortality.

CLINICAL IMPLICATIONS: In ARDS patients, ST2 may be considered as a useful biomarker for prognostication, identifying high risk of death patients.

DISCLOSURE: The following authors have nothing to disclose: Marina García de Acilu, Oriol Roca, Joan Ramon Masclans, Laura Ruano, Jordi Rello

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