Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, The Netherlands.
BMC Pulm Med. 2009 Dec 3;9:49. doi: 10.1186/1471-2466-9-49.
Despite consensus criteria, diagnosing acute lung injury, or its more severe form acute respiratory distress syndrome (ALI/ARDS) remains challenging. Adding objective measures, such as plasma levels of biological markers could facilitate recognition of ALI/ARDS. This study was designed to assess and compare the diagnostic accuracy of biological markers for ALI/ARDS with ventilator-associated pneumonia (VAP).
We performed serial measurements of Clara cell protein (CC16), soluble receptor for advanced glycation end products (sRAGE), surfactant protein D (SP-D) and Krebs von den Lungen (KL-6) in plasma of patients with VAP and mechanically ventilated control patients without VAP. ALI/ARDS was diagnosed using the criteria of the North-American European consensus conference.
Thirty-seven patients were enrolled - 22 patients with VAP and 15 control patients. Ten patients with pneumonia met the ALI/ARDS consensus criteria. Control patients never met these criteria. Plasma CC16 had a good diagnostic capacity for ALI/ARDS as shown by the receiver operating characteristic curve with an area under the curve of 0.91 (95% confidence interval (CI) 0.79 - 1.00; p < 0.001). Identification of ALI/ARDS patients by sudden increases in plasma CC16 of 30% or more yielded a sensitivity of 90% and a specificity of 92%. Of note, levels of CC16 increased 2 days before ALI/ARDS diagnosis. A cut-off level of 50 ng/ml SP-D yielded a specificity of 100% while the sensitivity was 70%. The area under the curve for SP-D was 0.80 (95% CI 0.58 - 1.00; p = 0.02). The diagnostic accuracies of KL-6 and sRAGE were low.
Plasma CC16 seems a potential biological marker for ALI/ARDS in patients with VAP. Plasma levels of sRAGE, SP-D and KL-6 have limited discriminative power for diagnosing ALI/ARDS in VAP.
尽管有共识标准，但急性肺损伤（ALI）或其更严重形式急性呼吸窘迫综合征（ARDS）的诊断仍然具有挑战性。添加客观指标，如生物标志物的血浆水平，可以帮助识别 ALI/ARDS。本研究旨在评估和比较生物标志物对呼吸机相关性肺炎（VAP）相关 ALI/ARDS 的诊断准确性。
我们对 VAP 患者和无 VAP 的机械通气对照患者的血浆中克拉拉细胞蛋白（CC16）、晚期糖基化终产物可溶性受体（sRAGE）、表面活性蛋白 D（SP-D）和 Krebs von den Lungen-6（KL-6）进行了连续测量。ALI/ARDS 的诊断采用北美-欧洲共识会议的标准。
共纳入 37 例患者，其中 22 例为 VAP 患者，15 例为对照患者。10 例肺炎患者符合 ALI/ARDS 共识标准。对照患者从未符合这些标准。血浆 CC16 的诊断能力良好，ROC 曲线下面积为 0.91（95%置信区间（CI）0.79-1.00；p<0.001）。通过突然增加 30%或更多的血浆 CC16 来识别 ALI/ARDS 患者，其敏感性为 90%，特异性为 92%。值得注意的是，CC16 水平在 ALI/ARDS 诊断前 2 天升高。SP-D 的截断值为 50ng/ml 时，特异性为 100%，而敏感性为 70%。SP-D 的 AUC 为 0.80（95%CI 0.58-1.00；p=0.02）。KL-6 和 sRAGE 的诊断准确性较低。
血浆 CC16 似乎是 VAP 患者 ALI/ARDS 的潜在生物标志物。SP-D、KL-6 和 sRAGE 的血浆水平对诊断 VAP 中的 ALI/ARDS 具有有限的鉴别能力。
