Back to Search
Start Over
Alveolar compartmentalization of inflammatory and immune cell biomarkers in pneumonia-related ARDS
- Source :
- Critical Care, Vol 25, Iss 1, Pp 1-13 (2021)
- Publication Year :
- 2021
- Publisher :
- Springer Science and Business Media LLC, 2021.
-
Abstract
- Background Biomarkers of disease severity might help individualizing the management of patients with the acute respiratory distress syndrome (ARDS). Whether the alveolar compartmentalization of biomarkers has a clinical significance in patients with pneumonia-related ARDS is unknown. This study aimed at assessing the interrelation of ARDS/sepsis biomarkers in the alveolar and blood compartments and explored their association with clinical outcomes. Methods Immunocompetent patients with pneumonia-related ARDS admitted between 2014 and 2018 were included in a prospective monocentric study. Bronchoalveolar lavage (BAL) fluid and blood samples were obtained within 48 h of admission. Twenty-two biomarkers were quantified in BAL fluid and serum. HLA-DR+ monocytes and CD8+ PD-1+ lymphocytes were quantified using flow cytometry. The primary clinical endpoint of the study was hospital mortality. Patients undergoing a bronchoscopy as part of routine care were included as controls. Results Seventy ARDS patients were included. Hospital mortality was 21.4%. The BAL fluid-to-serum ratio of IL-8 was 20 times higher in ARDS patients than in controls (p p = 0.026), IL-6 (p = 0.002), IP-10/CXCL10 (p = 0.024) and IL-10 (p = 0.023) than others. The BAL fluid-to-serum ratio of IL-1Ra was more elevated in hospital survivors than decedents (p = 0.006), even after adjusting for SOFA and driving pressure (p = 0.036). There was no significant association between alveolar or alveolar/blood monocytic HLA-DR or CD8+ lymphocytes PD-1 expression and hospital mortality. Conclusions IL-8 was the most compartmentalized cytokine and lower BAL fluid-to-serum concentration ratios of IL-1Ra were associated with hospital mortality in patients with pneumonia-associated ARDS.
- Subjects :
- Adult
medicine.medical_specialty
ARDS
Respiratory distress syndrome
medicine.medical_treatment
Critical Care and Intensive Care Medicine
Gastroenterology
Sepsis
03 medical and health sciences
0302 clinical medicine
Internal medicine
PD-1
Clinical endpoint
Medicine
Clinical significance
030212 general & internal medicine
medicine.diagnostic_test
business.industry
HLA-DR antigens
lcsh:Medical emergencies. Critical care. Intensive care. First aid
030208 emergency & critical care medicine
Pneumonia
lcsh:RC86-88.9
medicine.disease
Bronchoalveolar lavage
Cytokine
Shock (circulatory)
Cytokines
medicine.symptom
business
Subjects
Details
- ISSN :
- 13648535
- Volume :
- 25
- Database :
- OpenAIRE
- Journal :
- Critical Care
- Accession number :
- edsair.doi.dedup.....6da6771a93012dc34443056ffd8321c7