Tuberc Respir Dis.  2008 Aug;65(2):99-104.

Inflammatory Markers as Prognostic Factors for Patients with ARDS

• Chung CU
• Hwang JH
• Park JW
• Shin JY
• Jung SY
• Lee JE
• Park HS
• Jung SS
• Kim JO
• Kim SY

Abstract

BACKGROUND: Acute respiratory distress syndrome (ARDS) is ultimately an inflammatory state. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level are inflammatory markers. The aim of this study was to evaluate the value of the ESR, CRP and APACHE II score as prognostic factors for patient with ARDS.
METHODS
We retrospectively analyzed the medical records of 87 ARDS patients. The predictors (APACHE II score, ESR and CRP) and outcomes (mortality and length of the total hospital stay, the ICU stay and mechanical ventilator care) were obtained from the patients' records. The patients were grouped according to survival as the Survivor and Non survivor groups. We compared the APACHE II score, the ESR and the CRP level between the survivor group and the nonsurvivor group. We evaluated the correlation between the predictors and the outcomes. The initial ESR, CRP level and APACHE II score were checked at the time of ICU admission and the second ESR and CRP level were checked 3.3+/-1.2 days after ICU admission.
RESULTS
Thirty-eight (43.7%) patients remained alive and 49 (56.3%) patients died. The APACHE II score was significantly lower for the survivor group than that for the non survivor group (14.7+/-7.6 vs 19.6+/-9.1, respectively, p=0.006). The initial ESR and CRP level were not different between the survivor and non-survivor groups (ESR 64.0+/-37.8 mm/hr vs 63.3+/-36.7 mm/hr, respectively, p=0.93, CRP 15.5+/-9.6 mg/dl vs 16.3+/-8.5 mg/dl, respectively, p=0.68). The decrement of the CRP level for the survivor group was greater than that for the non survivor group (-8.23+/-10.0 mg/dl vs -1.46+/-10.1 mg/dl, respectively, p=0.003). Correlation analysis revealed the initial ESR was positively correlated with the length of the total hospital stay and the ICU stay (correlation coefficient of the total hospital days: R=0.43, p=0.001, correlation coefficient of the ICU stay: R=0.39, p=0.014).
CONCLUSION
The initial APACHE II score can predict the mortality of ARDS patients, and the degree of the early CRP change can be a predictor of mortality for ARDS patients. The initial ESR has positive correlation with the ARDS patients' duration of the total hospital stay and the ICU stay.

Keyword

APACHE II; Acute respiratory distress syndrome; C reactive protein; Erythrocyte sedimentation rate; Prognosis

MeSH Terms

APACHE
Blood Sedimentation
C-Reactive Protein
Humans
Length of Stay
Medical Records
Prognosis
Respiratory Distress Syndrome, Adult
Retrospective Studies
Survivors
Ventilators, Mechanical
C-Reactive Protein

Reference

1. Spragg R. Surfactant for Acute Lung Injury. Am J Respir Cell Mol Biol. 2007. 37:377–378.

2. Leaver SK, Evans TW. Acute respiratory distress syndrome. BMJ. 2007. 335:389–394.

3. Piantadosi CA, Schwartz DA. The acute respiratory distress syndrome. Ann Intern Med. 2004. 141:460–470.

4. Huh JW, Lim CM, Jegal YJ, Lee SD, Kim WS, Kim DS, et al. The effect of steroid therapy in patients with late ARDS. Tuberc Respir Dis. 2002. 52:376–384.

5. Ashbaugh DG, Bigelow DB, Petty TL, Levine BE. Acute respiratory distress in adults. Lancet. 1967. 2:319–323.

6. Bone RC, Maunder R, Slotman G, Silverman H, Hyers TM, Kerstein MD, et al. An early test of survival in patients with the adult respiratory distress syndrome: the PaO2/FiO2 ratio and its response to conventional therapy. Prostaglandin E1 Study Group. Chest. 1989. 96:849–851.

7. Headley AS, Tolley E, Meduri GU. Infections and the inflammatory response in acute respiratory distress syndrome. Chest. 1997. 111:1306–1321.

8. Meduri GU, Headley AS, Golden E, Carson SJ, Umberger RA, Kelso T, et al. Effect of prolonged methylprednisolone therapy in unresolving acute respiratory distress syndrome. JAMA. 1998. 280:159–165.

9. Safavi M, Honarmand A. Comparison of infection probability score, APACHE II, and APACHE III scoring systems in predicting need for ventilator and ventilation duration in critically ill patients. Arch Iran Med. 2007. 10:354–360.

10. Ramirez M. The value of the APACHE II scoring in relation to outcome among post cardiorespiratory arrest patients. Philipp J Intern Med. 2001. 39:42–47.

11. Chen YC, Lin YC, Lin MC, Chang HW, Huang CC, Tsai YH. ICU discharge APACHE II scores help to predict post-ICU death. Chang Gung Med J. 2007. 30:142–150.

12. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985. 13:818–829.

13. Knaus WA, Wagner DP, Draper EA. The APACHE III prognostic system: risk prediction of hospital mortality for critically ill hospitalized adults. Chest. 1991. 100:1619–1636.

14. Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European /North American multicenter study. JAMA. 1993. 270:2957–2963.

15. Park JW, Chung SW, Ko SB, Choi YB, Lee KS. Predictive value of C-reactive protein in the differential diagnosis of acute meningitis in adults. J Korean Neurol Assoc. 2003. 21:248–254.

16. Kim SH, Lee WY, Park JY, Park HS, Han HK, Ju HS, et al. Diagnostic value of C-reactive protein and vascular endothelial growth factor in differentiation of pleural effusions. Tuberc Respir Dis. 2003. 55:467–477.

17. Ha JS, Lee JS, Kim HJ, Moon TG, Chang DK, Lee JH, et al. Comparative usefulness of erythrocyte sedimentation rate and C-creactive protein in assessing the severity of ulcerative colitis. Korean J Gastroenterol. 2006. 48:313–320.

18. Peltola HO. C-reactive protein for rapid monitoring of infections of the central nervous system. Lancet. 1982. 1:980–982.

19. Chalmers JD, Singanayagam A, Hill AT. C-reactive protein is an independent predictor of severity in community-acquired pneumonia. Am J Med. 2008. 121:219–225.

20. Hilgenfeldt U, Kellermann W, Kienapfel G, Jochum M. Relationship between angiotensinogen, α1-protease inhibitor elastase complex, antithrombin III and C-reactive protein in septic ARDS. Eur J Clin Pharmacol. 1990. 38:125–131.

21. Povoa P. C-reactive protein: a valuable marker of sepsis. Intensive Care Med. 2002. 28:235–243.

22. Bernard GR, Luce JM, Sprung CL, Rinaldo JE, Tate RM, Sibbald WJ, et al. High-dose corticosteroids in patients with the acute respiratory distress syndrome. N Engl J Med. 1987. 317:1565–1570.

23. Meduri GU. The role of the host defence response in the progression and outcome of ARDS: pathophysiological correlations and response to glucocorticoid treatment. Eur Respir J. 1996. 9:2650–2670.

24. Hameed MA, Wagas S. Physiological basis and clinical utility of erythrocyte sedimentation rate. Pak J Med Sci. 2006. 22:214–218.

25. Cox ML, Rudd AG, Gallimore R, Hodkinson HM, Pepys MB. Real-time measurement of serum C-reactive protein in the management of infection in the elderly. Age Ageing. 1986. 15:257–266.

26. Povoa P, Coelho L, Almeida E, Fernandes A, Mealha R, Moreira P, et al. C-reactive protein as a marker of infection in critically ill patients. Clin Microbiol Infect. 2005. 11:101–108.