Plasma CC16 levels are associated with development of ALI/ARDS in patients with ventilator-associated pneumonia: A retrospective observational study

被引：60
作者：
Determann R.M. [1 ,2 ]
Millo J.L. [3 ]
Waddy S. [3 ]
Lutter R. [4 ,5 ]
Garrard C.S. [3 ]
Schultz M.J. [1 ,2 ,6 ]
机构：
[1] Department of Intensive Care Medicine, Academic Medical Center, Amsterdam
[2] Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A), Academic Medical Center, Amsterdam
[3] Department of Intensive Care Medicine, John Radcliffe Hospital, Oxford
[4] Department of Experimental Immunology, Academic Medical Center, Amsterdam
[5] Department of Pulmonology, Academic Medical Center, Amsterdam
[6] HERMES Critical Care Group, Amsterdam
来源：
BMC Pulmonary Medicine | / 9卷 / 1期
关键词：
Epithelial Line Fluid; Lung Injury Score; Clinical Pulmonary Infection Score; sRAGE Level; CC16 Level;
D O I：
10.1186/1471-2466-9-49
中图分类号：
学科分类号：
摘要：
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). Methods: 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. Results: 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. Conclusion: 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. © 2009 Determann et al; licensee BioMed Central Ltd.
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