Open Access Research

The predictive role of serum and bronchoalveolar lavage cytokines and adhesion molecules for acute respiratory distress syndrome development and outcome

Panagiotis Agouridakis1, Despina Kyriakou2, Michael G Alexandrakis2, Athanasios Prekates4, Kostas Perisinakis5, Nikolaos Karkavitsas6 and Demosthenes Bouros3*

Author Affiliations

1 Intensive Care Unit, General Hospital of Rethymnon, Crete, Greece

2 Department of Hematology, University Hospital of Heraklion, Crete, Greece

3 Department of Pneumonology, University Hospital of Heraklion, Crete, Greece

4 Intensive Care Unit, Tzanion General Hospital of Pireus, Crete, Greece

5 Department of Medical Physics, University Hospital of Heraklion, Crete, Greece

6 Department of Nuclear Medicine, University Hospital of Heraklion, Crete, Greece

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Respiratory Research 2002, 3:25 doi:10.1186/rr193

Published: 23 October 2002

Abstract

Background

The predictive role of many cytokines and adhesion molecules has not been studied systematically in acute respiratory distress syndrome (ARDS).

Methods

We measured prospectively tumour necrosis factor alpha (TNF-α), interleukin (IL)-1, soluble vascular adhesion molecule-1 (VCAM-1) and soluble intercellular adhesion molecule-1 (ICAM-1) in serum and bronchoalveolar lavage fluid (BALF) within 2 hours following admission, in 65 patients. The patients were divided into: those fulfilling the criteria for ARDS (n = 23, group A), those who were pre-ARDS and who developed ARDS within 24 hours (n = 14, group B), and those on pre-ARDS but who never developed ARDS (n = 28, group C).

Results

All the measured molecules were only found at higher levels in the serum of patients that died either with or without ARDS (P < 0.05 – P < 0.0001). Patients at risk exhibited a good negative predictive value (NPV) of the measured molecules for ARDS development both in their serum (89 to 95%) and BALF (86 to 92%) levels. In contrast to BALF, serum levels of IL-1 and adhesion molecules exhibited a good NPV (68 to 96%), sensitivity (60 to 88%) and survival specificity (74 to 96%) in all groups. All molecules in serum and BALF IL-1 were correlated with the APACHE II (P < 0.05 – P < 0.0001). Serum and BALF IL-1 as well as BALF TNF-α were negatively correlated to PaO2/FiO2 (all P < 0.05).

Conclusions

The studied molecules have good NPV for ARDS development both in serum and BALF. Serum rather than BALF levels seem to be related to outcome.

Keywords:
ARDS; adhesion molecules; BAL; cytokines; survival