Andrijevic Ana, Batranovic Uros, Nedeljkov Djordje, Gavrilovic Srdjan, Carapic Vladimir, Milic Svetislava, Matijasevic Jovan, Andrijevic Ilija
Medical Faculty, University of Novi Sad, 21000 Novi Sad, Serbia.
Intensive Care Unit, Institute for Pulmonary Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia.
Medicina (Kaunas). 2025 Jan 27;61(2):229. doi: 10.3390/medicina61020229.
: Acute respiratory distress syndrome (ARDS) is a severe form of acute lung injury with high mortality, characterized by hypoxemic respiratory failure and diffuse lung damage. Despite advancements in care, no definitive biomarkers have been established for ARDS diagnosis and prognostic stratification. Soluble receptor for advanced glycation end-products (sRAGE), a marker of alveolar epithelial injury, has shown promise as a prognostic indicator in ARDS. This study evaluates sRAGE's utility in predicting 28-day mortality. : A retrospective cohort study was conducted at a tertiary care ICU in Serbia from January 2021 to June 2023. Adult patients meeting the Berlin definition of ARDS were included. Exclusion criteria included pre-existing chronic respiratory diseases and prolonged mechanical ventilation before diagnosis. Serum sRAGE levels were measured within 48 h of ARDS diagnosis using enzyme-linked immunosorbent assay (ELISA). Clinical severity scores, laboratory markers, and ventilatory parameters were recorded. Logistic regression and survival analyses were used to assess the prognostic value of sRAGE for 28-day mortality. : A cohort of 121 patients (mean age 55.5 years; 63.6% male) was analyzed. Non-survivors exhibited higher median sRAGE levels than survivors (5852 vs. 4479 pg/mL, = 0.084). The optimal sRAGE cut-off for predicting mortality was >16,500 pg/mL (sensitivity 30.4%, specificity 86.9%). Elevated sRAGE levels were associated with greater disease severity and an increased risk of 28-day mortality in ARDS patients, highlighting its potential as a prognostic biomarker. The main findings, while indicative of a trend toward higher sRAGE levels in non-survivors, did not reach statistical significance. : The main findings, while indicative of a trend toward higher sRAGE levels in non-survivors, did not reach statistical significance ( = 0.084). sRAGE demonstrates potential as a prognostic biomarker in ARDS and has moderate correlation with 28-day mortality. Integrating sRAGE with other biomarkers could enhance risk stratification and guide therapeutic decisions. The retrospective design limits the ability to establish causation, underscoring the need for multicenter prospective studies.
急性呼吸窘迫综合征（ARDS）是急性肺损伤的一种严重形式，死亡率高，其特征为低氧性呼吸衰竭和弥漫性肺损伤。尽管在治疗方面取得了进展，但尚未确立用于ARDS诊断和预后分层的确定性生物标志物。晚期糖基化终末产物可溶性受体（sRAGE）作为肺泡上皮损伤的标志物，已显示出有望成为ARDS的预后指标。本研究评估了sRAGE在预测28天死亡率方面的效用。
2021年1月至2023年6月在塞尔维亚一家三级护理重症监护病房进行了一项回顾性队列研究。纳入符合ARDS柏林定义的成年患者。排除标准包括既往存在慢性呼吸系统疾病以及诊断前长期机械通气。在ARDS诊断后48小时内使用酶联免疫吸附测定（ELISA）测量血清sRAGE水平。记录临床严重程度评分、实验室指标和通气参数。采用逻辑回归和生存分析评估sRAGE对28天死亡率的预后价值。
分析了一组121例患者（平均年龄55.5岁；63.6%为男性）。非幸存者的sRAGE中位数水平高于幸存者（5852对4479 pg/mL，P = 0.084）。预测死亡率的最佳sRAGE临界值>16,500 pg/mL（敏感性30.4%，特异性86.9%）。sRAGE水平升高与ARDS患者疾病严重程度增加和28天死亡率风险增加相关，突出了其作为预后生物标志物的潜力。主要研究结果虽表明非幸存者中sRAGE水平有升高趋势，但未达到统计学显著性。
主要研究结果虽表明非幸存者中sRAGE水平有升高趋势，但未达到统计学显著性（P = 0.084）。sRAGE在ARDS中显示出作为预后生物标志物的潜力，且与28天死亡率有中度相关性。将sRAGE与其他生物标志物相结合可加强风险分层并指导治疗决策。回顾性设计限制了确立因果关系的能力，强调了开展多中心前瞻性研究的必要性。
