Predictive efficacy of plasma arginase 1 as a novel biomarker for mechanical ventilated patients with sepsis induced acute respiratory distress syndrome: a prospective cohort study

Abstract

While acute respiratory distress syndrome (ARDS) is the highest mortality with the worse outcomes among other causes of ARDS, a few studies focused on the risk identification of sepsis-ARDS. Here, this study determined the levels of plasma arginase 1 (ARG1) to apply as a novel biomarker for sepsis-ARDS. A total of 46 endotracheal intubated patients with ARDS categorized as sepsis-ARDS (n = 28) and non-sepsis ARDS (n = 18) were enrolled. The clinical outcomes were obtained prospectively and ARG1 level was determined by ELISA. Plasma ARG1 in sepsis-ARDS was higher than non-sepsis ARDS and correlated with ARDS severity, including APACHE II score, SOFA score, interleukin-6, lactate, and the reduced PaO2/FiO2 ratio. Additionally, the higher plasma ARG1 in sepsis-ARDS indicated the higher mortality and the longer duration of ventilator use. There was a non-significant correlation in patients with non-sepsis ARDS. The area under the curves (AUC) in a receiver operating characteristic (ROC) curve of ARG1 for the prediction of 28-days mortality and ventilator free day in sepsis-ARDS were 0.80 and 0.67, respectively, while AUC to diagnose sepsis-ARDS was 0.72, All the performances were improved when combined the ARG1 levels with SOFA score. Moreover, the relationship between plasma ARG1 and neutrophils was demonstrated. Flow cytometry demonstrated a high level of neutrophil ARG1 production with high degranulation levels, supporting the role of neutrophils in ARG1 production during sepsis-ARDS. In conclusion, the plasma ARG1 levels may be a potential marker for predicting the worsen outcomes of sepsis-ARDS. Early detection of plasma ARG1 could help clinicians to manage sepsis-ARDS.

Keywords: Acute respiratory distress syndrome; Arginase 1; Biomarker; Neutrophil; Sepsis.