Lesur Olivier, Langevin Stephan, Berthiaume Yves, Légaré Martin, Skrobik Yoanna, Bellemare Jean-François, Lévy Bruno, Fortier Yvan, Lauzier Francois, Bravo Gina, Nickmilder Marc, Rousseau Eric, Bernard Alfred
Groupe de Recherche en Physiopathologie Respiratoire, Centre de Recherche Clinique, Centre Hospitalier Universitaire de Sherbrooke 3001, 12 Avenue Nord, Sherbrooke, Canada.
Intensive Care Med. 2006 Aug;32(8):1167-74. doi: 10.1007/s00134-006-0235-1. Epub 2006 Jun 23.
Injury to the alveolocapillary barrier characterizes ALI/ARDS; therefore determining levels of lung epithelium-specific small proteins in serum may help predict clinical outcomes. We examined whether serum Clara cell protein (CC-16) concentration is correlated with the outcome, mechanical ventilation duration, and incidence of nonpulmonary organ failure.
Prospective multicenter observational study conducted by the Quebec Critical Care Network.
Seventy-eight adult ARDS patients requiring mechanical ventilation were enrolled and 28-day mortality was the primary outcome. Ventilatory parameters were computed and blood was sampled daily. Clinical information collected included cause of death, duration of mechanical ventilation, number of ventilator-free days, and organ failures.
Median serum levels of CC-16 were significantly higher in nonsurvivors than survivors on days 0-2 (19.93 microg/l, IQR 11.8-44.32, vs. 8.9, 5.66-26.38) and sustained up to day 14. CC-16 levels were correlated positively with the number of failing organs (rho 0.3623) and requirement for prolonged mechanical ventilation. Predictors of patient mortality included age, arterial carbon dioxide partial pressure, CC-16, and APACHE II score (odds ratios 1.35, 1.52, 1.37, 1.159, respectively).
Higher initial CC-16 serum level is associated with increased risk of death, fewer ventilator-free days, and increased frequency of nonpulmonary multiple organ failure. CC-16 is a valuable biomarker of ARDS that may help predict outcome among ARDS patients with high-risk mortality.
肺泡毛细血管屏障损伤是急性肺损伤/急性呼吸窘迫综合征（ALI/ARDS）的特征；因此，测定血清中肺上皮特异性小蛋白的水平可能有助于预测临床结局。我们研究了血清克拉拉细胞蛋白（CC-16）浓度是否与结局、机械通气时间及非肺器官衰竭的发生率相关。
由魁北克重症监护网络进行的前瞻性多中心观察性研究。
纳入78例需要机械通气的成年ARDS患者，以28天死亡率作为主要结局。计算通气参数并每日采集血样。收集的临床信息包括死亡原因、机械通气时间、无呼吸机天数及器官衰竭情况。
在第0 - 2天，非存活者的CC-16血清中位数水平显著高于存活者（19.93微克/升，四分位间距11.8 - 44.32，vs. 8.9，5.66 - 26.38），并持续至第14天。CC-16水平与衰竭器官数量（rho 0.3623）及延长机械通气的需求呈正相关。患者死亡的预测因素包括年龄、动脉血二氧化碳分压、CC-16及急性生理与慢性健康状况评分系统II（APACHE II）评分（优势比分别为1.35、1.52、1.37、1.159）。
较高的初始CC-16血清水平与死亡风险增加、无呼吸机天数减少及非肺多器官衰竭频率增加相关。CC-16是ARDS的一个有价值的生物标志物，可能有助于预测高死亡风险的ARDS患者的结局。
