Acute lung injury in patients with traumatic injuries: utility of a panel of biomarkers for diagnosis and pathogenesis.

Fremont RD, Koyama T, Calfee CS, Wu W, Dossett LA, Bossert FR, Mitchell D, Wickersham N, Bernard GR, Matthay MA, May AK, Ware LB
J Trauma. 2010 68 (5): 1121-7

PMID: 20038857 · PMCID: PMC3347639 · DOI:10.1097/TA.0b013e3181c40728

BACKGROUND - The diagnosis of acute lung injury (ALI) is based on a consensus clinical definition. Despite the simplicity of this definition, ALI remains underdiagnosed and undertreated. Severe trauma is a well-described cause of ALI that represents a relatively homogeneous subset of patients with ALI. The aims of this study were to develop a panel of plasma biomarkers to facilitate diagnosis of trauma-induced ALI and to enhance our understanding of the pathogenesis of human ALI.

METHODS - A retrospective nested case control of 192 patients admitted to the trauma intensive care unit at a university hospital between 2002 and 2006. We compared 107 patients with ALI to 85 patients without ALI. Plasma was collected within 72 hours of intensive care unit admission. Twenty-one plasma biomarkers were measured in duplicate in each plasma sample.

RESULTS - Patients with ALI had higher severity of illness scores, more days of mechanical ventilation, longer hospital stays, and higher mortality versus controls. Seven biomarkers (receptor for advanced glycation end products, procollagen peptide III, brain natriuretic peptide, angiopoietin-2, interleukin-10, tumor necrosis factor alpha, and interleukin-8) had a high diagnostic accuracy as reflected by the area under the receiver operating characteristic curve of 0.86 (95% confidence interval, 0.82-0.92) in differentiating ALI from controls.

CONCLUSIONS - A model using seven plasma biomarkers had a high diagnostic accuracy in differentiating patients with trauma-induced ALI from trauma patients without ALI. In addition, use of a panel of biomarkers provides insight into the likely importance of alveolar epithelial injury in the pathogenesis of early ALI.

MeSH Terms (29)

Acute Lung Injury Adult Angiopoietin-2 Biomarkers Case-Control Studies Causality Collagen Type III Discriminant Analysis Female Hospitals, University Humans Interleukin-8 Interleukin-10 Length of Stay Logistic Models Male Middle Aged Multivariate Analysis Natriuretic Peptide, Brain Predictive Value of Tests Receptor for Advanced Glycation End Products Receptors, Immunologic Respiration, Artificial Retrospective Studies Sensitivity and Specificity Severity of Illness Index Statistics, Nonparametric Tumor Necrosis Factor-alpha Wounds and Injuries

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