Alveolar plasminogen activator inhibitor-1 predicts ARDS in aspiration pneumonitis.
Intensive Care Med
; 32(1): 110-5, 2006 Jan.
Article
en En
| MEDLINE
| ID: mdl-16284739
OBJECTIVE: To test the hypothesis that alveolar plasminogen activator inhibitor-1 (PAI-1) can identify patients with witnessed aspiration at risk for progression to acute respiratory distress syndrome (ARDS). DESIGN: Prospective observational study. SETTING: Medical intensive care unit in a tertiary care center. PATIENTS: Fifty-one patients with witnessed aspiration who had a PaO2/FIO2<300 for a period no less than 4 h from admission. INTERVENTIONS: Alveolar fluid sampling was performed within 8 h of intubation via luminal suction of the distal airways using a 13-Fr catheter. Plasma levels were collected simultaneously by venipuncture. MEASUREMENTS AND RESULTS: Alveolar PAI-1 antigen levels were more than five times higher in those who progressed to ARDS than in those with uncomplicated aspiration pneumonitis (2687+/-1498 ng/ml vs. 587+/-535 ng/ml, respectively; p<0.001), while plasma levels of PAI-1 antigen were not significantly different between the two groups. The measured activity of PAI-1 antigen paralleled the levels observed in both media. A cut-off level of alveolar PAI-1 >1518 ng/ml was found to be 82.4% (56.6%-96.0%) sensitive and 97.1% (84.6%-99.5%) specific in predicting progression to ARDS. There was also a significant inverse relationship between elevation of PAI-1 antigen levels and the degree of lung injury as assessed by the days of unassisted ventilation (r2=0.37; p<0.001). CONCLUSIONS: Elevation of alveolar PAI-1 antigen levels postaspiration is the consequence of local rather than systemic activation of the fibrinolytic system. Measurement of alveolar PAI-1 antigen levels can be a useful clinical marker in predicting progression to ARDS after gastric aspiration.
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Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Neumonía por Aspiración
/
Alveolos Pulmonares
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Síndrome de Dificultad Respiratoria
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Inhibidor 1 de Activador Plasminogénico
Tipo de estudio:
Diagnostic_studies
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Evaluation_studies
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Observational_studies
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Prognostic_studies
Límite:
Adult
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Female
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Humans
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Male
Idioma:
En
Revista:
Intensive Care Med
Año:
2006
Tipo del documento:
Article
País de afiliación:
Estados Unidos
Pais de publicación:
Estados Unidos