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* From the National Jewish Medical Center and Denver Health Medical Center, Departments of Medicine, Pulmonary, and Critical Care Medicine, Denver, CO.
Correspondence to: K.E. Greene, MD, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Health Sciences Center, National Jewish Medical and Research Center, 1400 Jackson St, Denver, CO 80206
Patients with
ARDS have significant quantitative and qualitative surfactant
abnormalities. We, and others, have shown that patients with
established ARDS have decreased BAL surfactant protein (SP)-A levels
and increased serum SP-A. We hypothesized that serum SP-A levels
reflect epithelial cell injury and would, therefore, predict the
development of ARDS in patients at risk for the syndrome. To
investigate this, we measured serum SP-A levels in patients who were at
risk for developing ARDS from sepsis, trauma, or aspiration of gastric
contents and from normal healthy volunteers. Patients were enrolled as
part of the ARDS Specialized Center of Research project within
8 h of being identified as being at risk and serum samples were
obtained within 12 h. Patients were then followed up to determine
if they ultimately developed the syndrome. SP-A levels were measured
using a double monoclonal antibody sandwich enzyme-linked immunosorbent
assay. SP-A levels were compared using one-way analysis of variance
with Tukey-Kramer test for multiple comparisons. Significance was
assigned at a p value of < 0.05. Overall, baseline SP-A levels in all
at-risk patients who ultimately developed ARDS were significantly
higher when compared with those patients who did not develop the
syndrome (123 ng/mL, [n = 26] vs 30 ng/mL [n = 25]). Subgroup
analysis revealed that baseline serum SP-A levels in patients who
developed ARDS from either sepsis or aspiration were significantly
higher when compared to patients with the same risk factors who did not
develop ARDS (sepsis: 253 ng/mL [n = 6] vs 32 ng/mL [n = 6];
aspiration: 93 ng/mL [n = 4] vs 33 ng/mL [n = 4]). In contrast,
SP-A levels in trauma patients who developed ARDS (46 ng/mL
[n = 15]) were not different from trauma patients who did not
develop ARDS (42 ng/mL [n = 16]), and were identical to normal
volunteers (30 ng/mL [n = 16]). In conclusion, baseline serum SP-A
levels appear to predict the development of ARDS in patients at risk
from sepsis and aspiration, but not trauma. These results are
consistent with other studies demonstrating differences in circulating
endothelial markers, endotoxin, and tumor necrosis factor-
in
patients with sepsis compared to patients with trauma. Our findings
suggest that serum SP-A levels may allow for early identification of
patients at high risk for developing ARDS and may help in the
development of specific targeted therapeutic
interventions.
This article has been cited by other articles:
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  M D Eisner, P Parsons, M A Matthay, L Ware, and K Greene Plasma surfactant protein levels and clinical outcomes in patients with acute lung injury Thorax, November 1, 2003; 58(11): 983 - 988. [Abstract] [Full Text] [PDF]
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 E. I. Majeski, M. K. Paintlia, A. D. Lopez, R. A. Harley, S. D. London, and L. London Respiratory Reovirus 1/L Induction of Intraluminal Fibrosis, a Model of Bronchiolitis Obliterans Organizing Pneumonia, Is Dependent on T Lymphocytes Am. J. Pathol., October 1, 2003; 163(4): 1467 - 1479. [Abstract] [Full Text] [PDF]
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