Diagnostic Accuracy of Plasma Ghrelin Concentrations in Pediatric Sepsis-Associated Acute Respiratory Distress Syndrome: A Single-Center Cohort Study

Background: Ghrelin is the endogenous ligand of growth hormone secretagogue receptor 1a, which plays a role in regulating immunity and inflammation. The aim of this study is to assess the diagnostic value of plasma ghrelin in sepsis-associated pediatric acute respiratory distress syndrome (PARDS).Methods: We recruited patients who were admitted to the pediatric ICU (PICU) of the Children's Hospital of Chongqing Medical University between January 2019 and January 2020 and met the diagnostic criteria for sepsis. Data on clinical variables, laboratory indicators, plasma ghrelin concentrations, and inflammatory factors were collected and evaluated, and patients were followed up for 28 days. The area under the receiver-operating characteristic curves (AUROC) were determined using logistic regression to calculate and test cut-off values for ghrelin as a diagnostic indicator of sepsis-associated PARDS. The log-rank test was used to compare survival according to ghrelin levels.Main results: Sixty-six PICU patients (30 with ARDS and 36 without ARDS) who met the diagnostic criteria of sepsis were recruited. The ghrelin level was significantly higher in the ARDS group than in the non-ARDS group. The AUROC of ghrelin was 0.708 (95% confidence interval: 0.584–0.833) and the positivity cutoff value was 445 pg/mL. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of plasma ghrelin for the diagnosis of PARDS-associated sepsis were 86.7, 50.0, 59.1, 81.8, 1.734, and 0.266%, respectively. The survival rate of sepsis patients were significantly improved when the ghrelin level was >445 pg/mL.Conclusions: Ghrelin plasma levels were higher in sepsis-associated PARDS, and accompanied by increased levels of inflammatory factors. High ghrelin levels are a positive predictor of ICU survival in sepsis patients. Yet, there is no evidence to prove that elevated ghrelin is a promising diagnostic indicator of sepsis-associated PARDS.Trial registration: Clinicaltrials, ChiCTR1900023254. Registered 1 December 2018 - Retrospectively registered, http://www.clinicaltrials.gov/ChiCTR1900023254.

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Clinical Utility of Surgical Lung Biopsy for Patients with Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis

Respiration ◽

10.1159/000519675 ◽

2021 ◽

pp. 1-11

Author(s):

Hiroyuki Hashimoto ◽

Shota Yamamoto ◽

Hiroaki Nakagawa ◽

Yoshihiro Suido ◽

Shintaro Sato ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Likelihood Ratio ◽

Lung Biopsy ◽

Clinical Utility ◽

Distress Syndrome ◽

Short Term ◽

Surgical Lung Biopsy ◽

Short Term Mortality

Background: Surgical lung biopsy (SLB) is performed in patients with acute respiratory distress syndrome (ARDS); however, its clinical utility remains unclear. Objectives: We categorized the pathological diagnoses and investigated the predictive value for short-term mortality. Method: Three electronic databases (MEDLINE, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov) were searched for the included studies. The QUADAS-2 was used to evaluate the risk of bias and its applicability. The types and populations of pathological diagnoses were investigated. The pooled sensitivity, positive likelihood ratio (LR+), negative likelihood ratio (LR−), and diagnostic odds ratio (DOR) were estimated at a fixed specificity. Hierarchical summary receiver operating characteristic curves were drawn. Results: A total of 16 studies that enrolled 758 patients were included. The pathological diagnoses were as follows: diffuse alveolar damage (DAD) 29.9%; infection 24.7%; interstitial lung disease 17.2%; malignancy 3.6%; cardiovascular disease 3.6%; drug toxicity 2.3%; connective tissue disease 2.2%; allergic disease 1.1%; and nonspecific diagnosis 15.4%. To predict short-term mortality, 13 studies that enrolled 613 patients used DAD as an index test and recorded a mortality rate of 56.9% (349 of 613 patients). A total of 3 studies that used index tests other than DAD were excluded. The pooled sensitivity, fixed specificity, LR+, LR−, and DOR were 0.46 (95% confidence interval [CI]: 0.29–0.56), 0.69, 1.48 (95% CI: 0.92–1.81), 0.78 (95% CI: 0.63–1.03), and 1.90 (95% CI: 0.89–2.86), respectively. Conclusions: SLB is unlikely to provide a specific diagnosis and should not be recommended for confirming DAD or predicting ARDS prognosis.

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Diagnostic Accuracy of Plasma Ghrelin Concentrations in Pediatric Sepsis -associated ARDS: A Single-center Cohort Study

10.21203/rs.3.rs-49171/v1 ◽

2020 ◽

Author(s):

xiu yuan ◽

Shaojun Li ◽

Liang Zhou ◽

yanru LI ◽

tian tang ◽

...

Keyword(s):

Diagnostic Criteria ◽

Likelihood Ratio ◽

Predictive Value ◽

Protective Factor ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Ghrelin Level ◽

Inflammatory Factors ◽

Rank Test ◽

Growth Hormone Secretagogue

Abstract Background: Ghrelin is the endogenous ligand of growth hormone secretagogue receptor 1a (GHSR1a), which can regulate immunity and inflammation. To assess the diagnostic value of plasma ghrelin levels in sepsis-associated pediatric acute respiratory distress syndrome (PARDS).Methods: We recruited patients from the PICU of a third-class teaching hospital who met the diagnostic criteria for sepsis from January 2019 to January 2020. Clinical data, laboratory indicators, plasma ghrelin concentrations, and inflammatory factors of cohort were evaluated in detail, and patients were followed up for 28 days. The area under the receiver-operating characteristic curves (AUROC) was calculated using logistic regression to calculate and positivity cut-offs was tested. Ghrelin's ability to diagnose and differentiate sepsis-associated PARDS were determined. The log-rank test was used to compare the survival curves of different ghrelin level groups.Main results: Sixty-six PICU patients (30 with ARDS, 36 without ARDS) who met the diagnostic criteria of sepsis were recruited. The ghrelin level was significantly higher in the sepsis patients of the ARDS group than in those of the non-ARDS group. The AUROC of ghrelin was 0.708 (95% confidence interval: 0.584–0.833) and the positivity cutoff value was 445 pg/mL. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (+LR), and negative likelihood ratio (–LR) of plasma ghrelin for diagnosis of sepsis with PARDS were 86.7%, 50.0%, 59.1%, 81.8%,1.734, and 0.266, respectively. The survival rate of sepsis patients was significantly improved when the ghrelin level was >445 pg/mL.Conclusions: Ghrelin plasma was higher in sepsis-associated PARDS, and accompanied by the increase of inflammatory factors. The increased plasma ghrelin may be due to the anti-inflammatory response, which may be a protective factor in children with sepsis. Yet, there is no evidence to prove that elevated ghrelin appears to be a promising diagnostic indicator of sepsis-associated PARDS. In addition, the ghrelin levels may be a positive predictor of sepsis.Trial registration: Clinicaltrials, ChiCTR1900023254. Registered 1 December 2018 - Retrospectively registered, http://www.clinicaltrials. gov/ChiCTR1900023254.

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Desflurane Attenuates Ventilator-Induced Lung Injury in Rats with Acute Respiratory Distress Syndrome

BioMed Research International ◽

10.1155/2018/7507314 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 2

Author(s):

Xue Lin ◽

Ying-nan Ju ◽

Wei Gao ◽

Dong-mei Li ◽

Chang-chun Guo

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Lung Injury ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Tidal Volume ◽

Lung Tissue ◽

Rat Model ◽

Distress Syndrome ◽

Inflammatory Factors ◽

Ventilator Induced Lung Injury

Ventilator-induced lung injury aggravates the existing lung injury. This study investigated the effect of desflurane on VILI in a rat model of acute respiratory distress syndrome. Forty-eight rats were randomized into a sham (S) group, control (C) group, lipopolysaccharide/ventilation (LV) group, lipopolysaccharide/ventilation/desflurane (LVD) group, or lipopolysaccharide/low ventilation with and without desflurane (LLV and LLVD) groups. Rats in the S group received anesthesia only. Rats in the LV and LVD groups received lipopolysaccharide and were ventilated with a high tidal volume. Rats in LLV and LLVD groups were treated as the LV and LVD groups and ventilated with a low tidal volume. PaO2/FiO2, lung wet-to-dry weight ratios, concentrations of inflammatory factors in serum and BALF, histopathologic analysis of lung tissue, and levels of nuclear factor- (NF-) κB protein in lung tissue were investigated. PaO2/FiO2 was significantly increased by desflurane. Total cell count, macrophages, and neutrophils in BALF and proinflammatory factors in BALF and serum were significantly decreased by desflurane, while IL-10 was increased. The histopathological changes and levels of NF-κB protein in lung tissue were decreased by desflurane. The results indicated that desflurane ameliorated VILI in a rat model of acute respiratory distress syndrome.

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Diagnostic value of miR-155 for acute lung injury/acute respiratory distress syndrome in patients with sepsis

Journal of International Medical Research ◽

10.1177/0300060520943070 ◽

2020 ◽

Vol 48 (7) ◽

pp. 030006052094307

Author(s):

Zhou-Feng Wang ◽

Yu-Min Yang ◽

Heng Fan

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Acute Lung Injury ◽

Lung Injury ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Characteristic Curve ◽

Diagnostic Value ◽

Inflammatory Factors ◽

Tnf Α

Objective We aimed to investigate the diagnostic value of microRNA-155 (miR-155) for acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) in patients with sepsis. Methods In this prospective study, we used Spearman correlation analysis to investigate relationships between miR-155 expression and inflammatory factors, oxygenation ratio (PaO2/FiO2), and ALI/ARDS score, and used area under the receiver operating characteristic curve (AU-ROC) to evaluate miR-155's diagnostic accuracy for ALI/ARDS in patients with sepsis. Results In total, 156 patients with sepsis were enrolled in our study, of which 41 had ALI and 32 had ARDS. miR-155 expression in plasma of patients with sepsis and ALI/ARDS was significantly higher than that of patients with sepsis but no ALI/ARDS. The miR-155 level in patients with sepsis and ALI/ARDS was positively correlated with interleukin (IL)-1β and tumor necrosis factor (TNF)-α levels and ALI/ARDS score, but negatively correlated with PaO2/FiO2. The AU-ROC of plasma miR-155 for diagnosis of sepsis with ALI/ARDS was 0.87, and plasma miR-155, IL-1β, and TNF-α had high sensitivity and specificity for the diagnosis of sepsis with ALI/ARDS. Conclusion miR-155 is highly expressed in plasma of patients with septic ALI/ARDS; it is positively correlated with lung function and can be used for early diagnosis.

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Renal dysfunction reduces the diagnostic and prognostic value of serum CC16 for acute respiratory distress syndrome in intensive care patients

BMC Pulmonary Medicine ◽

10.1186/s12890-020-01245-0 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Jinle Lin ◽

Wuyuan Tao ◽

Jian Wei ◽

Jian Wu ◽

Wenwu Zhang ◽

...

Keyword(s):

Renal Function ◽

Acute Respiratory Distress Syndrome ◽

Intensive Care ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Normal Renal Function ◽

Predictive Value ◽

Distress Syndrome ◽

Icu Patients ◽

Cutoff Value

Abstract Background Contradictory results regarding changes in serum club cell protein 16 (CC16) levels in patients with acute respiratory distress syndrome (ARDS) have been reported, challenging the value of CC16 as a diagnostic and prognostic marker for ARDS. We have also observed increased serum CC16 levels in patients with renal dysfunction (RD). Therefore, the present study aimed to determine whether RD affects the diagnostic performance of CC16 for ARDS in intensive care unit (ICU) patients. Methods We measured serum CC16 concentrations in 479 ICU patients, who were categorized into six groups according to their diagnoses: control, acute kidney injury (AKI), chronic kidney disease (CKD), ARDS, ARDS+AKI, and ARDS+CKD. The sensitivity, specificity, and cutoff values for serum CC16 were assessed by receiver operating characteristic curve analysis. Results Serum CC16 concentrations were higher in the ARDS group than in the control group, and in ARDS patients with normal renal function, serum CC16 could identify ARDS and predict survival outcomes at 7 and 28 days. However, serum CC16 levels were similar among the ARDS+AKI, ARDS+CKD, AIK, and CKD groups. Consequently, in patients with AKI and/or CKD, the specificity of CC16 for diagnosing ARDS or ARDS+RD decreased from 86.62 to 2.82% or 81.70 to 2.12%, respectively. Consistently, the CC16 cutoff value of 11.57 ng/ml in patients with RD differed from the established values of 32.77–33.72 ng/ml with normal renal function. Moreover, the predictive value of CC16 for mortality in ARDS+RD patients was lost before 7 days but regained by 28 days. Conclusion RD reduces the diagnostic specificity, diagnostic cutoff value, and predictive value for 7-day mortality of serum CC16 for ARDS among ICU patients.

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External Validity of Electronic Sniffers for Automated Recognition of Acute Respiratory Distress Syndrome

Journal of Intensive Care Medicine ◽

10.1177/0885066617720159 ◽

2017 ◽

Vol 34 (11-12) ◽

pp. 946-954 ◽

Cited By ~ 3

Author(s):

Andrew C. McKown ◽

Ryan M. Brown ◽

Lorraine B. Ware ◽

Jonathan P. Wanderer

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Predictive Value ◽

Gold Standard ◽

Distress Syndrome ◽

Screening Tools ◽

Test Characteristics ◽

Simpler Algorithm ◽

Automated Screening

Introduction: Automated electronic sniffers may be useful for early detection of acute respiratory distress syndrome (ARDS) for institution of treatment or clinical trial screening. Methods: In a prospective cohort of 2929 critically ill patients, we retrospectively applied published sniffer algorithms for automated detection of acute lung injury to assess their utility in diagnosis of ARDS in the first 4 ICU days. Radiographic full-text reports were searched for “edema” OR (“bilateral” AND “infiltrate”) and a more detailed algorithm for descriptions consistent with ARDS. Patients were flagged as possible ARDS if a radiograph met search criteria and had a PaO2/FiO2 or SpO2/FiO2 of 300 or 315, respectively. Test characteristics of the electronic sniffers and clinical suspicion of ARDS were compared to a gold standard of 2-physician adjudicated ARDS. Results: Thirty percent of 2841 patients included in the analysis had gold standard diagnosis of ARDS. The simpler algorithm had sensitivity for ARDS of 78.9%, specificity of 52%, positive predictive value (PPV) of 41%, and negative predictive value (NPV) of 85.3% over the 4-day study period. The more detailed algorithm had sensitivity of 88.2%, specificity of 55.4%, PPV of 45.6%, and NPV of 91.7%. Both algorithms were more sensitive but less specific than clinician suspicion, which had sensitivity of 40.7%, specificity of 94.8%, PPV of 78.2%, and NPV of 77.7%. Conclusions: Published electronic sniffer algorithms for ARDS may be useful automated screening tools for ARDS and improve on clinical recognition, but they are limited to screening rather than diagnosis because their specificity is poor.

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Predictive Value of Serum β2‑Microglobulin for Outcomes in Patients with Acute Respiratory Distress Syndrome Caused by Bacterial Infection

10.21203/rs.3.rs-668831/v1 ◽

2021 ◽

Author(s):

Na Cui ◽

Xiaokai Feng ◽

Chunguo Jiang ◽

Jing Wang ◽

Liming Zhang

Keyword(s):

Risk Factor ◽

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Bacterial Infection ◽

Predictive Value ◽

Independent Risk Factor ◽

Distress Syndrome ◽

Survival Group ◽

Β2 Microglobulin

Abstract Background Acute respiratory distress syndrome (ARDS) is a heterogeneous disease with extremely high mortality. We hypothesized that the serum β2-microglobulin (β2MG) level would be elevated and be an independent risk factor for 28-day mortality in patients with ARDS. Methods We retrospectively enrolled 257 patients with ARDS caused by bacterial infection who were admitted consecutively into the Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital from January 1, 2015 to February 28, 2021. Patients were followed for up to 28 days from diagnosis and were divided into a survival group and non-survival group according to their clinical outcomes. The serum β2MG levels and other clinical data were collected. The relationship between serum β2MG levels and 28-day mortality was explored by performing a Cox regression analysis adjusted for age, updated Charlson comorbidity index, disorders of consciousness, septic shock, albumin level, cardiac troponin I level, procalcitonin level, lactic acid level, prothrombin time, and partial pressure of arterial oxygen/fraction of inspired oxygen ratio. Results In this cohort, 161 patients survived, and 96 patients died within 28 days of diagnosis, yielding a 28-day mortality of 37.4%. The median level of β2MG for all enrolled patients was 4.6 (interquartile range [IQR]: 2.9–8.5) mg/L. Higher β2MG levels were significantly associated with 28-day mortality when the β2MG level was analysed as a continuous variable (hazard ratio [HR]: 1.050; 95% confidence interval [CI]: 1.012–1.091; P = 0.010) and when it was categorized into tertiles (HR: 1.482; 95% CI: 1.069–2.045; P = 0.018). The serum β2MG level exhibited a diagnostic accuracy for predicting mortality that was not inferior to those of the Acute Physiology and Chronic Health Evaluation score (P = 0.153) and Sequential Organ Failure Assessment score (P = 0.114). Conclusions The level of serum β2MG is elevated and is an independent risk factor of 28-day mortality in patients with ARDS, suggesting that it has predictive value for the outcomes of these patients.

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Renal dysfunction decreases specificity and overturns cutoff value of serum CC16 while prohibiting 7-day mortality prediction in diagnosing acute respiratory distress syndrome in intensive care unit.

10.21203/rs.2.20735/v1 ◽

2020 ◽

Author(s):

Jinle Lin ◽

Wuyuan Tao ◽

Jian Wei ◽

Wu Jian ◽

Wenwu Zhang ◽

...

Keyword(s):

Intensive Care Unit ◽

Acute Respiratory Distress Syndrome ◽

Intensive Care ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Renal Dysfunction ◽

Predictive Value ◽

Distress Syndrome ◽

Icu Patients ◽

Cutoff Value

Abstract Background: A contradictory tendency between occurrence of acute respiratory distress syndrome (ARDS) and serum club cell protein 16 (CC16) level, However, renal dysfunction (RD) separately raised serum CC16 in our current observation. The purpose of this study was to find the limitation caused by renal dysfunction in the diagnostic performance of CC16 on ARDS in intensive care unit (ICU) patients. Method: We measured serum CC16 in 479 ICU patients. Patients were divided into six subgroups: control, acute kidney injury (AKI), chronic kidney dysfunction (CKD), ARDS, ARDS+AKI, and ARDS+CKD. The cutoff value, sensitivity and specificity of serum CC16 were assessed by receiver operating characteristic curves. Result: Serum CC16 increased among the ARDS group when compared to the control group, which helps identify ARDS and predicts the outcome in patients with normal renal function. However, level of serum CC16 was similar among ARDS+AKI, ARDS+CKD, AIK and CKD groups. Consequently, when compare to AKI and CKD, specificity for diagnosing whether ARDS or ARDS with renal failure decreased from 86.62% to 2.82% or 81.70% to 2.12%. Consistently, a cutoff value of 11.57 ng/mL was overturned from previously at 32.77 ng/mL or 33.72 ng/mL. Moreover, its predictive value for mortality is prohibited before 7 day but works after 28 day. Conclusion: Renal dysfunction limits the specificity, cutoff point, and predictive value at 7-day mortality of CC16 in diagnosing ARDS among ICU patients.

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