Elevated Plasma Levels of sRAGE Are Associated With Nonfocal CT-Based Lung Imaging in Patients With ARDS A Prospective Multicenter Study

Segolene Mrozek , Matthieu Jabaudon , Samir Jaber (1, 2) , Catherine Paugam-Burtz (3) , Jean-Yves Lefrant (4, 5) , Jean-Jacques Rouby (6) , Karim Asehnoune (7, 8) , Bernard Allaouchiche (9) , Olivier Baldesi , Marc Leone (10) , Qin Lu (6) , Jean-Etienne Bazin (11) , Laurence Roszyk , Vincent Sapin (12) , Emmanuel Futier (11) , Bruno Pereira (13) , Jean-Michel Constantin (11)

1 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
2 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
3 Hôpital Beaujon
4 Pôle d'anesthésie-réanimation-urgences
5 EA 2992 - Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires
6 CHU Pitié-Salpêtrière [AP-HP]
7 EA 3826 - Thérapeutiques cliniques et expérimentales des infections (EA 3826)
8 Service d'Anesthésie-Réanimation [CHU Limoges]
9 Service de Réanimation
10 URMITE - Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes
11 Service d'Anésthésie Réanimation [CHU Clermont-Ferrand]
12 Laboratoire de Biochimie
13 Unité de biostatistiques

BACKGROUND: During ARDS, CT can reveal two distinct lung imaging patterns, focal or non-focal, with different responses to positive end-expiratory pressure, recruitment maneuvers, and prone position. Nevertheless, their association with plasma biomarkers and their distinct functional/pathobiological mechanisms are unknown. The objective of this study was to characterize focal and nonfocal patterns of lung CT-based imaging with plasma markers of lung injury. METHODS: A prospective multicenter cohort study involving 119 consecutive patients with ARDS. Plasma biomarkers (soluble form of the receptor for advanced glycation end product [sRAGE], plasminogen activator inhibitor-1, soluble intercellular adhesion molecule-1, and surfactant protein-D) were measured within 24 h of ARDS onset. Lung CT scan was performed within the first 48 h to assess lung morphology. RESULTS: Thirty-two (27%) and 87 (73%) patients had focal and nonfocal ARDS, respectively. Plasma levels of sRAGE were significantly higher in nonfocal ARDS, compared with focal ARDS. A cut-off of 1,188 pg/mL differentiated focal from nonfocal ARDS with a sensitivity of 94% and a specificity of 84%. Nonfocal patterns were associated with higher 28- and 90-day mortality than focal patterns (31% vs 12%, P = .038 and 46% vs 21%, P = .026, respectively). Plasma levels of plasminogen activator inhibitor-1 were significantly higher in nonfocal ARDS. There was no difference in other biomarkers. CONCLUSIONS: Plasma sRAGE is associated with a nonfocal ARDS. Such novel findings may suggest a role for RAGE pathway in an underlying endotype of impaired alveolar fluid clearance and stimulate future research on the association between ARDS phenotypes and therapeutic responses.

Domaines: Maladies infectieuses

Segolene Mrozek, Matthieu Jabaudon, Samir Jaber, Catherine Paugam-Burtz, Jean-Yves Lefrant, et al.. Elevated Plasma Levels of sRAGE Are Associated With Nonfocal CT-Based Lung Imaging in Patients With ARDS A Prospective Multicenter Study. Chest, 2016, 150 (5), pp.998-1007. ⟨10.1016/j.chest.2016.03.016⟩. ⟨hal-01453297⟩