Examining the Association Between Angiopoietin-2 Levels and Acute Respiratory Distress Syndrome Subtypes in Critically Ill Patients with Sepsis
Year: 2021
Type: conference-abstract
Abstract: RATIONALE: There are currently no biomarkers that reliably predict acute respiratory distress syndrome (ARDS). Angiopoietin-2 (Ang-2), a marker of lung endothelial injury, was shown to be elevated in patients with ARDS, and elevated in patients with indirect ARDS vs. those with direct ARDS. However, most prior studies of Ang-2 in ARDS have examined heterogeneous patient populations. We performed a pilot study to examine the association between Ang-2 and ARDS specifically in patients with sepsis. METHODS: This was a secondary analysis of a biorepository of critically ill patients with sepsis and/or ARDS at Grady Memorial Hospital. Among participants with sepsis enrolled between 2014-2019 with plasma samples available, 66 patients were randomly selected. The primary outcome of ARDS according to the Berlin definition and other clinical information was collected from the study database and chart reviews, without knowledge of Ang-2 levels. Direct ARDS and indirect ARDS were defined as ARDS related to pneumonia/aspiration and other infection sites, respectively. Ang-2 levels were measured from the stored plasma samples using enzyme-linked immunosorbent assays. Multivariate logistic regression analyses were performed to examine the association between log-transformed Ang-2 levels, ARDS diagnosis, and subtype of ARDS. RESULTS: 29 (44%) patients with ARDS and 37 (56%) patients without ARDS were analyzed. Among patients with ARDS, 18 patients had direct ARDS and 10 patients had indirect ARDS; one patient was removed due to missing data. Sequential organ failure assessment (SOFA) score on day of enrollment was higher in ARDS patients vs. non-ARDS patients (median [interquartile range] 9.5 [6.0-11.0] vs. 6.0 [5.0-9.0], p=0.005), but other baseline characteristics were similar. Ang-2 level was the lowest in direct ARDS patients compared to indirect ARDS and non-ARDS patients (Figure In a logistic regression analysis, higher Ang-2 level was associated with lower odds of ARDS (odds ratio [OR]=0.40, 95% confidence interval [CI] 0.16-0.98, p=0.045). In a logistic regression comparing direct ARDS vs. indirect ARDS, higher Ang-2 level was significantly associated with increased odds of indirect ARDS (OR=6.80, p=0.041). CONCLUSION: In our study, higher Ang-2 level was associated with increased OR for indirect ARDS. This study applies and confirms the results of prior studies in a homogeneous population of patients with sepsis, and supports the potential role of Ang-2 in distinguishing ARDS subtypes in this population. A prospective evaluation would help validate the utility of Ang-2 and other ARDS biomarkers for distinguishing ARDS subtypes in patients with sepsis.
Authors: P. Yang, D. Sun, A. Manatunga, F. Harris, L. Wells, S. Bhavani, G.S. Martin, A.M. Esper
Institutions: Emory University, Children's Healthcare of Atlanta
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4248036730