Surfactant Protein D Is a Biomarker of Acute Respiratory Distress Syndrome
https://doi.org/10.15360/1813-9779-2013-4-11
Abstract
Acute respiratory distress syndrome (ARDS) is one of the major problems of reanimatology. Current technologies allow diagnosis of early-stage ARDS. At the same time, no objective parameters for assessing structural damage to the air-blood barrier are available. Biomarkers are promising in this respect. Objective: to estimate the informative value of the plasma and bronchoalveolar lavage (BAL) fluid levels of surfactant protein D (SP-D) as a candidate biomarker for early-stage ARDS. Subjects and methods. A multicenter observational study was conducted at the Clinics of the V. A. Negovsky Research Institute of General Reanimatology (RIGR), Russian Academy of Medical Sciences (RAMS), in 2010—2012. It enrolled 70 patients in accordance with inclusion and exclusion criteria and 30 healthy donors. ARDS and its stages were diagnosed using the criteria developed by the RIGR, RAMS. Blood and BAL SP-D levels were measured by the enzyme immunoassay Human Surfactant Protein D ELISA, RD194059101, BioVendor, USA. Statistical analysis of the findings was performed using a Statistica 7.0 package. ROC analysis was made to determine the sensitivity and specificity of SP-D. The difference was considered significant at pResults. During all study days (1, 3, 5, and 7), the plasma SP-D levels were significantly higher in the patients with ARDS than in those without this condition. On the same study days, these were significantly lower in patients with Stage 1 ARDS than in those with its Stage 2. On the same study days, the plasma SP-D content was significantly higher in deceased patients with ARDS than in survivors with this condition. The SP-D level of >115.8 ng/ml on study day 1 had a sensitivity of 82.5% and a specificity of 80.0% in diagnosing ARDS (area under the curve 0.87; 95% confidence interval 0.778-0.984; p=0.0026). That of Conclusion. The plasma SP-D level of >115.8 ng/ml is a sensitive and specific biomarker °f ARDS and that °f Key words: acute respiratory distress syndrome, surfactant protein D, biomarker, diagnosis, sepsis.
About the Authors
V. V. MorozA. M. Golubev
A. N. Kuzovlev
V. M Pisarev
A. K. Shabanov
M. A. Golubev
References
1. Мороз В.В., Голубев А.М.Общая реаниматология.
2. Мороз В.В., Голубев А.М.Принципы диагностики ранних проявлений острого повреждения легких.Общая реаниматология.2006; 2 (4): 5—7.
3. Мороз В.В., Власенко А.В., Голубев А.М., Яковлев В.Н., Алексеев В.Г., Булатов Н.Н., Смелая Т.В.Патогенез и дифференциальная диагностика острого респираторного дистресс-синдрома, обусловленного прямыми и непрямыми этиологическими факторами.Общая реаниматология.2011; 7 (3): 5—1
4. Власенко А.В., Голубев А.М., Мороз В.В., Яковлев В.Н., Алексеев В.Г.Дифференцированное лечение острого респираторного дистресс-синдрома.Общая реаниматология.2011; 7 (4): 5—1
5. Голубев А.М., Мороз В.В., Сундуков Д.В.Патогенез острого респираторного дистресс-синдрома.Общая реаниматология.2012; 8 (4): 13—22.
6. Кузовлев А.Н., Мороз В.В., Голубев А.М., Половников С.Г., Смелая Т.В.Диагностика острого респираторного дистресс-синдрома при нозо-комиальной пневмонии.Общая реаниматология.2009; 5 (6): 5—12.
7. Марченков Ю.В., Власенко А.В., Мороз В.В., Яковлев В.Н.Эволюция диагностики и лечения острого респираторного дистресс-синдрома на основе новейших медицинских технологий.Общая реаниматология.2012; 8 (4): 22—30.
8. Голубев А.М., Антошина Е.М., Марченков Ю.В., Мороз В.В., Кузов-лев А.Н., Сундуков Д.В.Морфологические изменения легких при закрытой травме груди (экспериментальное исследование).Общая реаниматология.2012; 8 (2): 11—14.
9. Кузьков В.В., Киров М.Ю.Инвазивный мониторинг гемодинамики в интенсивной терапии и анестезиологии. Архангельск: Правда Севера; 2008.
10. Proudfoot A., Hind M., Griffiths M.Biomarkers of acute lung injury: worth their salt?BMC Med.2011; 9: 132.
11. Гриппи М.Патофизиология легких. М.: БИНОМ; 2001.
12. Ware L.B., Koyama T., Billheimer D.D., Wu W., Bernard G.R., Thompson B.T., Brower R.G., Standiford T.J., Martin T.R., Matthay M.A.; NHLBI ARDS Clinical Trials Network.Prognostic and patho-genetic value of combining clinical and biochemical indices in patients with acute lung injury.Chest.2010; 137 (2): 288—296.
13. Galsser J., Mallampalli R.Surfactants and its role in the pathology of pulmonary infection.Microbes Infect.2012; 14 (1): 17—25.
14. Determann R., Royakkers A., HaitsmaJ., Zhang H., Slutsly A., Ranieri V., Schultz M.Plasma levels of surfactant protein D and KL-6 for evaluation of lung injury in critically ill mechanically ventilated patients.BMCPulm. Med.2010; 10 (6): 6—15.
15. Eisner M.D., Parsons P., Matthay M.A., Ware L., Greene K.; Acute Respiratory Distress Syndrome Network.Plasma surfactant protein levels and clinical outcomes in patients with acute lung injury.Thorax.2003; 58 (11): 983—988.
16. Greene K.E., Wright J.R., Steinberg K.P., Ruzinski J.T., Caldwell E., Wong W.B., Hull W., Whitsett J.A., Akino T., Kuroki Y., Nagae H., Hudson L.D., Martin T.R.Serial changes of surfactant-associated proteins in lung and serum before and after onset of ARDS.Am. J. Respir. Crit. Care Med.1999; 160 (6): 1843—1850.
17. Ware L.B., Matthay M.A.The acute respiratory distress syndrome.N. Engl. J. Med.2000; 342 (18): 1334—1349.
18. Doyle I., Bersten A., Nicholas T.Surfactant proteins A and B are elevated in plasma of patients with acute respiratory failure.Am. J. Respir. Crit. Care Med.1997; 156 (4 Pt 1): 1217—1229.
19. Cross L.J., Matthay M.A.Biomarkers of acute lung injury: insights into the pathogenesis of acute lung injury.Crit. Care Clin.2011; 27 (2): 355—377.
Review
For citations:
Moroz V.V., Golubev A.M., Kuzovlev A.N., Pisarev V.M., Shabanov A.K., Golubev M.A. Surfactant Protein D Is a Biomarker of Acute Respiratory Distress Syndrome . General Reanimatology. 2013;9(4):11. (In Russ.) https://doi.org/10.15360/1813-9779-2013-4-11
Views:
1488
Email this article 