[Significance of combined application of biomarkers in the diagnosis and prognosis assessment of patients with acute respiratory distress syndrome].

OBJECTIVE

To explore the clinical significance of the combined detection of Clara cell secretory protein 16 (CC16) and soluble receptor for advanced glycation end product (sRAGE) in the diagnosis and prognosis of acute respiratory distress syndrome (ARDS).

METHODS

100 ARDS patients admitted to the intensive care unit (ICU) of Chu Hsien-I Memorial Hospital of Tianjin Medical University from July 2019 to September 2020 were enrolled as the ARDS group, and 100 non-ARDS patients admitted to the ICU during the same period were enrolled as the control group. The general information, vital signs, blood gas analysis, serum CC16 and sRAGE levels, duration of mechanical ventilation, length of ICU stay and prognosis during hospitalization were collected. The receiver operating characteristic (ROC) curve was drawn and the area under ROC curve (AUC) was calculated to evaluate the clinical value of CC16 and sRAGE lonely or combination in the diagnosis and prognosis of ARDS.

RESULTS

The duration of mechanical ventilation in the ARDS group was significantly longer than that in the non-ARDS group (days: 15.44±3.04 vs. 12.61±3.73, P < 0.01), and the hospitalization mortality was higher (38.0% vs. 9.0%, P < 0.01), but there was no significant difference in gender, age, body mass index (BMI), acute physiology and chronic health evaluation II (APACHE II) score or the length of ICU stay between the two groups. There were 62 ARDS patients survived and 38 ARDS patients died during hospitalization. The APACHE II score of the death group was significantly higher than that of the survival group (23.55±2.83 vs. 19.40±4.10, P < 0.01), but there was no significant difference in age, BMI, oxygenation index, mean arterial pressure, duration of mechanical ventilation or the length of ICU stay between the two groups. The serum levels of CC16 and sRAGE in the ARDS group were significantly higher than those in the non-ARDS group [CC16 (mg/L): 38.78±14.70 vs. 21.87±2.45, sRAGE (pg/L): 2 470.95±288.70 vs. 2 013.22±131.15, both P < 0.01]; and the serum levels of CC16 and sRAGE of ARDS patients in the death group were significantly higher than those in the survival group [CC16 (mg/L): 42.02±10.81 vs. 30.52±9.47, sRAGE (pg/L): 2 638.34±324.07 vs. 2 279.91±163.70, both P < 0.01]. ROC curve showed that the AUC of CC16 and sRAGE in the diagnosis of ARDS alone were 0.859 [95% confidence interval (95%CI) was 0.808-0.911] and 0.821 (95%CI was 0.762-0.879), and the best cut-off values were 25.76 mg/L and 2 203.00 pg/L, respectively; the AUC of combined detection of CC16 and sRAGE was 0.932 (95%CI was 0.900-0.965) with the sensitivity of 89.0% and the specificity of 87.6%. The AUC of CC16 and sRAGE in predicting the death of patients with ARDS during hospitalization were 0.747 (95%CI was 0.651-0.843) and 0.819 (95%CI was 0.737-0.902), and the best cut-off values were 32.95 mg/L and 2 554.50 pg/L, respectively; the AUC of combined detection of CC16 and sRAGE was 0.900 (95%CI was 0.828-0.972) with the sensitivity of 88.7% and the specificity of 84.5%.

CONCLUSIONS

Serum CC16 and sRAGE have clinical value for the diagnosis and prognosis of ARDS. The combined detection of them is superior to individual detection for early prediction of ARDS and prognosis.