Plasma CC16 levels are associated with development of ALI/ARDS in patients with ventilator-associated pneumonia: a retrospective observational study

BMC Pulm Med. 2009 Dec 3;9:49. doi: 10.1186/1471-2466-9-49.

Abstract

Background: Despite consensus criteria, diagnosing acute lung injury, or its more severe form acute respiratory distress syndrome (ALI/ARDS) remains challenging. Adding objective measures, such as plasma levels of biological markers could facilitate recognition of ALI/ARDS. This study was designed to assess and compare the diagnostic accuracy of biological markers for ALI/ARDS with ventilator-associated pneumonia (VAP).

Methods: We performed serial measurements of Clara cell protein (CC16), soluble receptor for advanced glycation end products (sRAGE), surfactant protein D (SP-D) and Krebs von den Lungen (KL-6) in plasma of patients with VAP and mechanically ventilated control patients without VAP. ALI/ARDS was diagnosed using the criteria of the North-American European consensus conference.

Results: Thirty-seven patients were enrolled - 22 patients with VAP and 15 control patients. Ten patients with pneumonia met the ALI/ARDS consensus criteria. Control patients never met these criteria. Plasma CC16 had a good diagnostic capacity for ALI/ARDS as shown by the receiver operating characteristic curve with an area under the curve of 0.91 (95% confidence interval (CI) 0.79 - 1.00; p < 0.001). Identification of ALI/ARDS patients by sudden increases in plasma CC16 of 30% or more yielded a sensitivity of 90% and a specificity of 92%. Of note, levels of CC16 increased 2 days before ALI/ARDS diagnosis. A cut-off level of 50 ng/ml SP-D yielded a specificity of 100% while the sensitivity was 70%. The area under the curve for SP-D was 0.80 (95% CI 0.58 - 1.00; p = 0.02). The diagnostic accuracies of KL-6 and sRAGE were low.

Conclusion: Plasma CC16 seems a potential biological marker for ALI/ARDS in patients with VAP. Plasma levels of sRAGE, SP-D and KL-6 have limited discriminative power for diagnosing ALI/ARDS in VAP.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Lung Injury / blood*
  • Acute Lung Injury / diagnosis*
  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Case-Control Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Mucin-1 / blood
  • Pneumonia, Ventilator-Associated / blood*
  • Pneumonia, Ventilator-Associated / complications*
  • Pulmonary Surfactant-Associated Protein D / blood
  • ROC Curve
  • Receptor for Advanced Glycation End Products
  • Receptors, Immunologic / blood
  • Respiratory Distress Syndrome / blood*
  • Respiratory Distress Syndrome / diagnosis*
  • Retrospective Studies
  • Sensitivity and Specificity
  • Uteroglobin / blood*

Substances

  • Biomarkers
  • MUC1 protein, human
  • Mucin-1
  • Pulmonary Surfactant-Associated Protein D
  • Receptor for Advanced Glycation End Products
  • Receptors, Immunologic
  • SCGB1A1 protein, human
  • Uteroglobin