Chest
Original ResearchCritical Care MedicinePrognostic and Pathogenetic Value of Combining Clinical and Biochemical Indices in Patients With Acute Lung Injury
Section snippets
Patients
Patients were eligible for inclusion if they participated in the NHLBI ARDS Clinical Trials Network multicenter randomized controlled trial of two different PEEP titration strategies (the ALVEOLI study).15 There were 549 patients enrolled in the clinical trial. Of these patients, 528 were included in the current study, based solely on the availability of baseline plasma samples. The study protocol was approved by the institutional review board at each hospital. Informed consent was obtained
Patient Characteristics and Baseline Clinical and Biomarker Variables
Patient characteristics are shown in Table 1. The overall mortality was 27.3% and did not differ significantly by ventilator group. In univariable analysis, patients who died had higher APACHE III scores, more organ failures at enrollment, a higher alveolar to arterial oxygen gradient, and higher plateau pressures, and were more likely to have nonpulmonary sepsis as the underlying cause of ALI/ARDS. Patients who died also had significantly fewer organ failure-free and ventilator-free days. A
Discussion
This study provides strong evidence that a combination of biologic and clinical risk factors provides a superior prognostic index for mortality in patients with early ALI/ARDS, as compared with either biologic or clinical risk factors alone. In addition, we found that two plasma biomarkers, IL-8 and SP-D, had major prognostic value when combined with clinical risk factors, suggesting the importance of acute inflammation and alveolar epithelial injury in the pathogenesis and recovery from human
Acknowledgments
Author contributions: Dr Ware: contributed to designing the study, supervising all measurements made, analyzing the results, and writing the manuscript.
Dr Koyama: contributed to biostatistical analysis and editing the manuscript.
Dr Billheimer: contributed to biostatistical analysis and editing the manuscript.
Dr Wu: contributed to biostatistical analysis.
Dr Bernard: contributed to designing the study, analyzing the results, and editing the manuscript.
Dr Thompson: contributed to designing the
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Funding/Support: This study was supported by the National Institutes of Health [Grants HL81332, HR46059, HL74005, HL73996, HL74024, HL73994].
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).