Higher mini-BAL total protein concentration in early ARDS predicts faster resolution of lung injury measured by more ventilator-free days
Year: 2017
Type: article
Abstract: The protein concentration of alveolar edema fluid in acute respiratory distress syndrome (ARDS) is dynamic. It reflects alveolar flooding during acute injury, as well as fluid and protein clearance over time. We hypothesized that among ARDS patients treated with low tidal volume ventilation, higher concentrations of protein in mini-bronchoalveolar lavage (mBAL) samples would predict slower resolution of lung injury and worse clinical outcomes. Total protein and IgM concentrations in day 0 mBAL samples from 79 subjects enrolled in the aerosolized albuterol (ALTA) ARDS Network Albuterol Trial were measured by colorimetric assay and ELISA, respectively. Linear regression models were used to test the association of mBAL proteins with clinical outcomes and measures of length of illness, including ventilator-free days (VFDs). Median mBAL total protein concentration was 1,740 μg/ml [interquartile range (IQR): 890–3,170]. Each 500 μg/ml increase in day 0 mBAL total protein was associated with an additional 0.8 VFDs [95% confidence interval (CI): 0.05–1.6, P value = 0.038]. Median mBAL IgM concentration was 410 ng/ml (IQR: 340–500). Each 50 ng/ml increase in mBAL IgM was associated with an additional 1.1 VFDs (95% CI 0.2–2.1, P value = 0.022). These associations remained significant and were not attenuated in multivariate models adjusted for age, serum protein concentration, and vasopressor use in the 24 h before enrollment. Thus, higher mBAL total protein and IgM concentrations at day 0 are associated with more VFDs in patients with ARDS and may identify patients with preserved alveolar epithelial mechanisms for net alveolar fluid clearance.
Authors: Carolyn M. Hendrickson, Jason Abbott, Hanjing Zhuo, Kathleen D. Liu, Carolyn S. Calfee, Michael A. Matthay, NHLBI ARDS Network
Institution: University of California, San Francisco
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: Acute Respiratory Distress Syndrome after Isolated Traumatic Brain Injury: Platelet Biology, Endothelial Activation, and Mechanical Ventilation, The Risk of Acute Respiratory Distress Syndrome after Severe Isolated Traumatic B, Molecular Endotypes of ARDS: Identification, Biology, and Differential Response to Therapy, ARDS Endotypes: Expanded Analysis of Clinical and Biological Phenotypes and Evolution Over Time, G3693249427, G6084844149, G6563362131, Lung Fluid Balance and Mesenchymal Stem Cells, G8180801338, Cigarette Smoke Exposure and Acute Lung Injury After Severe Blunt Trauma, Multidisciplinary Training Program in Lung Disease, Resolution of Clinical Lung Injury, G959073637
OpenAlex ID: W2588864840