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01.01.2015 | Original

Type III procollagen is a reliable marker of ARDS-associated lung fibroproliferation

verfasst von: Jean-Marie Forel, Christophe Guervilly, Sami Hraiech, François Voillet, Guillemette Thomas, Claude Somma, Véronique Secq, Catherine Farnarier, Marie-Josée Payan, Stéphanie-Yannis Donati, Gilles Perrin, Delphine Trousse, Stéphanie Dizier, Laurent Chiche, Karine Baumstarck, Antoine Roch, Laurent Papazian

Erschienen in: Intensive Care Medicine | Ausgabe 1/2015

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Abstract

Purpose

A specific biomarker of post-ARDS fibroproliferation could be useful in the identification of patients who could benefit from therapies aiming to modulate fibroproliferation such as corticosteroids.The aim of this prospective study was to determine the best threshold of the N-terminal-peptidetype III procollagen (NT-PCP-III) in non-resolving ARDS to validate this threshold according to the outcome.

Methods

Concerning the best threshold of NT-PCP-III, all consecutive patients with a non-resolving ARDS were included if all the following criteria were fulfilled: moderate to severe ARDS lasting for at least 5 days, lung biopsy performed, serum and alveolar NT-PCP-III obtained within 1 week prior to biopsy, and no documented infection contra-indicating the corticosteroids. In the validation cohort part of the study, patients were included at day 7 if they presented a persistent moderate to severe ARDS.

Results

Nineteen of 32 patients had fibroproliferatio nonbiopsy. Serum and alveolar NT-PCP-III were higher in patients with fibroproliferation. Using a threshold of 9 µg/L, alveolar NT-PCP-III had the highest accuracy for diagnosing fibroproliferation (sensitivity = 89.5 % and specificity = 92.3 %). Regarding the 51 patients included in the validation cohort, the mortality rate at day 60 was increased in patients presenting an alveolar NT-PCP-III level higher than 9 µg/L (69 vs. 17 %, p < 0.001). The mean alveolar level of NT-PCP-III on day 7 was 8.1-fold higher in nonsurvivors (p = 0.03).

Conclusions

The determination of NT-PCP-III on BAL done at day 7 in persistent ARDS is able to identify patients with fibroproliferation who could be included in a trial of corticosteroids or any other treatment that might help resolve lung fibroproliferation.

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Titel: Type III procollagen is a reliable marker of ARDS-associated lung fibroproliferation
verfasst von: Jean-Marie Forel
Christophe Guervilly
Sami Hraiech
François Voillet
Guillemette Thomas
Claude Somma
Véronique Secq
Catherine Farnarier
Marie-Josée Payan
Stéphanie-Yannis Donati
Gilles Perrin
Delphine Trousse
Stéphanie Dizier
Laurent Chiche
Karine Baumstarck
Antoine Roch
Laurent Papazian
Publikationsdatum: 01.01.2015
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 1/2015
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-014-3524-0

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Type III procollagen is a reliable marker of ARDS-associated lung fibroproliferation