scholarly journals Discriminatory ability and prognostic evaluation of presepsin for sepsis-related acute respiratory distress syndrome

2020 ◽  
Author(s):  
Jiangnan Zhao ◽  
Yan Tan ◽  
Li Wang ◽  
Yi Shi
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Apache Ii ◽  
Discriminatory Ability ◽  
Prognostic Evaluation ◽  
Failure Assessment ◽  
Multicenter Prospective Cohort Study ◽  
Multicenter Prospective Cohort

Abstract Background Sepsis-related acute respiratory distress syndrome (ARDS) has worse clinical outcomes than non-sepsis-related ARDS. Early identification of sepsis-related or non-sepsis-related ARDS is challenging. Presepsin is known to be elevated in sepsis, but little is known about its discriminatory ability and prognostic evaluation in patients with sepsis-related ARDS.Methods This study was a multicenter prospective cohort study of 225 consecutive patients, enrolled based on the Berlin criteria for ARDS between September 2017 and August 2019. The patients were stratified into two groups: sepsis-related ARDS and non-sepsis-related ARDS. Plasma presepsin and serum procalcitonin (PCT) were measured, and the Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were calculated to evaluate disease severity.Results Patients with sepsis-related ARDS had higher presepsin levels at admission than patients with non-sepsis-related ARDS (P<0.001). The area under the receiver operating characteristic (ROC) curve of presepsin (0.81) was significantly greater than that of PCT (0.62) in diagnosing sepsis-related ARDS (P=0.001). Among patients with sepsis-related ARDS, presepsin levels were significantly higher in non-survivors than in survivors (P<0.001). Presepsin was found to be an independent predictor of in-hospital mortality in sepsis-related ARDS. Based on ROC analysis, the addition of presepsin improved discrimination based on SOFA or APACHE II scores from 0.77 to 0.87 or 0.73 to 0.85 (all P<0.05), respectively. The levels of plasma presepsin were positively correlated with disease severity, as determined by the SOFA score in the sepsis-related ARDS group (P<0.001).Conclusions Presepsin is a valuable biomarker for early stratification of sepsis-related ARDS. Higher plasma presepsin levels are associated with increased mortality in sepsis-related ARDS.

Long noncoding plasmacytoma variant translocation 1 facilitates the surveillance of acute respiratory distress syndrome and mortality prediction in sepsis

2021 ◽  
Vol 15 (6) ◽  
pp. 401-412
Author(s):  
Yijue Liu ◽  
Huan Peng ◽  
Feng Gui
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Disease Severity ◽  
Noncoding Rna ◽  
Distress Syndrome ◽  
Mortality Prediction ◽  
Prediction Of Mortality ◽  
Failure Assessment ◽  
Variant Translocation

Aim: We aimed to investigate the association of long noncoding RNA plasmacytoma variant translocation 1 (lncRNA PVT1) expression with acute respiratory distress syndrome (ARDS) risk and its prognostic value for 28-day mortality in sepsis patients. Materials & methods: LncRNA PVT1 expression from 109 sepsis patients and 100 health controls was detected. General sepsis severity was assessed using acute physiology and chronic health evaluation II score and sequential organ failure assessment score. Results: LncRNA PVT1 had an acceptable predictive value for higher ARDS risk, then was identified as an independent risk factor for sepsis ARDS; LncRNA PVT1 expression positively correlated with general disease severity in sepsis patients; LncRNA PVT1 was overexpressed in 28-day deaths compared with 28-day survivors in sepsis patients. Conclusion: LncRNA PVT1 may facilitate the surveillance of ARDS, general disease severity and the prediction of mortality in sepsis patients.

Etiology-associated heterogeneity in acute respiratory distress syndrome

2020 ◽  
Author(s):  
Sheng-Yuan Ruan ◽  
Chun-Ta Huang ◽  
Ying-Chun Chien ◽  
Chun-Kai Huang ◽  
Jung-Yien Chien ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Bacterial Pneumonia ◽  
Distress Syndrome ◽  
Hemodynamic Instability ◽  
Mechanically Ventilated ◽  
Significant Difference ◽  
Failure Assessment ◽  
Chi Squared

Abstract Background: Heterogeneity in acute respiratory distress syndrome (ARDS) has led to many statistically negative clinical trials. Etiology is considered an important source of pathogenesis heterogeneity in ARDS but previous studies have usually adopted a dichotomous classification, such as pulmonary versus extrapulmonary ARDS, to evaluate it. Etiology-associated heterogeneity in ARDS remains poorly described.Methods: In this retrospective cohort study, we described etiology-associated heterogeneity in gas exchange abnormality (PaO2/FiO2 [P/F] and ventilatory ratios), hemodynamic instability, non-pulmonary organ dysfunction as measured by the Sequential Organ Failure Assessment (SOFA) score, biomarkers of inflammation and coagulation, and 30-day mortality. Linear regression was used to model the trajectory of P/F ratios over time. Wilcoxon rank-sum tests, Kruskal-Wallis rank tests and Chi-squared tests were used to compare between-etiology differences. Results: From 1725 mechanically ventilated patients in the ICU, we identified 258 (15%) with ARDS. Pneumonia (48.4%) and non-pulmonary sepsis (11.6%) were the two leading causes of ARDS. Compared with pneumonia associated ARDS, extra-pulmonary sepsis associated ARDS had a greater P/F ratio recovery rate (difference = 13 mmHg/day, p = 0.01), more shock (48% versus 73%, p = 0.01), higher non-pulmonary SOFA scores (6 versus 9 points, p < 0.001), higher d-dimer levels (4.2 versus 9.7 mg/L, p = 0.02) and higher mortality (43% versus 67%, p = 0.02). In pneumonia associated ARDS, there was significant difference in proportion of shock (p = 0.005) between bacterial and non-bacterial pneumonia.Conclusion: This study showed that there was remarkable etiology-associated heterogeneity in ARDS. Heterogeneity was also observed within pneumonia associated ARDS when bacterial pneumonia was compared with other non-bacterial pneumonia. Future studies on ARDS should consider reporting etiology-specific data and exploring possible effect modification associated with etiology.

scholarly journals Lung ultrasound predicts acute respiratory distress syndrome in patients with paraquat intoxication

2017 ◽  
Vol 24 (6) ◽  
pp. 275-281 ◽  
Author(s):  
Xiao Lu ◽  
DingQian Wu ◽  
YuZhi Gao ◽  
Mao Zhang
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Organ Failure ◽  
Distress Syndrome ◽  
Lung Ultrasound ◽  
Lung Aeration ◽  
Failure Assessment ◽  
Ultrasound Score ◽  
The Impact

Objective: We assessed the evolution of lung aeration by “Lung Ultrasound Score” to predict the acute respiratory distress syndrome in patients with paraquat intoxication. Methods: Patients with paraquat intoxication treated in the intensive care unit were reviewed. Patients who had been assessed by transthoracic lung ultrasound at 3 time points as day 1, day 3, and day 7 after the treatment were analyzed. Lung aeration was represented by the lung ultrasound score. The relationship of the score with the development of acute respiratory distress syndrome was evaluated. Results: There were 50 patients included. On day 7, 18 patients developed the acute respiratory distress syndrome. The acute respiratory distress syndrome patients demonstrated a higher mortality rate than that for the non-acute respiratory distress syndrome patients (88.9% vs 31.5%, p < 0.001). In addition, the acute respiratory distress syndrome patients not only had a higher creatinine level (p < 0.001), and Sepsis-related Organ Failure Assessment 48-h scores (p < 0.001), and a longer time to gastric lavage but also suffered from a lower PaO2/FiO2 (p < 0.001) and a higher lung ultrasound score (p < 0.001) compared to those in the non-acute respiratory distress syndrome patients. The decrease in PaO2/FiO2 between day 3 and day 7 correlated with the increase in lung ultrasound score between day 3 and day 7. There was also a significant correlation between the Sepsis-related Organ Failure Assessment score and lung ultrasound score in acute respiratory distress syndrome patient on day 7. Conclusion: The transthoracic lung ultrasound may be a useful tool for lung aeration assessment on patients with paraquat intoxication receiving treatment. Further studies are needed to evaluate the impact of this screening strategy on predicting acute respiratory distress syndrome.

scholarly journals Clinical Phenotypes from Fatal Cases of Acute Respiratory Distress Syndrome Caused by Pneumonia

2021 ◽  
Author(s):  
Kazuya Ichikado ◽  
Kodai Kawamura ◽  
Takeshi Johkoh ◽  
Kiminori Fujimoto ◽  
Ayumi Shintani ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Early Death ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Late Death ◽  
Clinical Phenotypes ◽  
Death Group

Abstract Background: The COVID-19 pandemic has renewed interest and discussion about clinical phenotypes of acute respiratory distress syndrome (ARDS). Since the Berlin definition, various clinical disease courses with fatal outcome have been described but early objective indicators predicting distinct clinical courses have remained elusive. Objectives: Identify clinically available predictors that distinguish between two phenotypes of fatal ARDS due to pneumonia.Methods: 104 Japanese patients with pneumonia induced ARDS were extracted from our prospectively collected database. Fatal cases were divided into early (< 7 days after diagnosis) and late death (≥ 7 days) groups and their clinical variables and prognostic factors were statistically evaluated.Results: Of 50 cases, fatal within 180 days, 18 (36%) comprised the early death group (median 2 days, IQR [1, 5]) and 32 (64%), the late death group (median 16 days, IQR [13, 29]). Multivariate regression analyses showed APACHE II score (HR 1.14, 95%CI 1.01-1.28, p 0.047) was the only independent prognostic factor for early death. Late deaths were associated with disseminated intravascular coagulation score (HR 1.30, 95%CI 1.07-1.58, p 0.007), culture sensitivity to initial antimicrobials (HR 3.42, 95%CI 1.86-6.29, p <0.0001), and high-resolution computed tomography (HRCT) score indicating early fibroproliferation. ROC analyses estimated a late death propensity score for HRCT score ≥ 211, of 5.42 (95%CI 1.54–19.12; p 0.008).Conclusions: The extent of fibroproliferation on HRCT, along with coagulation abnormalities and APACHE II scores, should be considered for use in predictive trial enrichment and personalized medicine for patients with ARDS due to pneumonia.

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