Journal article
Plasma Soluble Suppression of Tumorigenicity-2 Associates with Ventilator Liberation in Acute Hypoxemic Respiratory Failure
American journal of respiratory and critical care medicine, Vol.203(10), pp.1257-1265
05/15/2021
DOI: 10.1164/rccm.202005-1951OC
PMCID: PMC8456472
PMID: 33400890
Abstract
Rationale: Standard physiologic assessments of extubation readiness in patients with acute hypoxemic respiratory failure (AHRF) may not reflect lung injury resolution and could adversely affect clinical decision-making and patient outcomes.
Objectives: We hypothesized that elevations in inflammatory plasma biomarkers sST2 (soluble suppression of tumorigenicity-2) and IL-6 indicate ongoing lung injury in AHRF and better inform patient outcomes compared with standard clinical assessments.
Methods: We measured daily plasma biomarkers and physiologic variables in 200 patients with AIIRF for up to 9 days after intubation. We tested the associations of baseline values with the primary outcome of unassisted breathing at Day 29. We analyzed the ability of serial biomarker measurements to inform successful ventilator liberation.
Measurements and Main Results: Baseline sST2 concentrations were higher in patients dead or mechanically ventilated versus breathing unassisted at Day 29 (491.7 ng/ml [interquartile range (IQR), 294.5-670.1 ng/ml] vs. 314.4 ng/ml [IQR, 127.5-550.1 ng/ml]; P = 0.0003). Higher sST2 concentrations over time were associated with a decreased probability of ventilator liberation (hazard ratio, 0.80 per log-unit increase; 95% confidence interval [CI], 0.75-0.83; P = 0.03). Patients with higher sST2 concentrations on the day of liberation were more likely to fail liberation compared with patients who remained successfully liberated (320.9 ng/ml [IQR, 181.1-495.6 ng/ml] vs. 161.6 ng/ml [IQR, 95.8-292.5 ng/ml]; P = 0.002). Elevated sST2 concentrations on the day of liberation decreased the odds of successful liberation when adjusted for standard physiologic parameters (odds ratio, 0.325; 95% CI, 0.119-0.885; P = 0.03). IL-6 concentrations did not associate with outcomes.
Conclusions: Using sST2 concentrations to guide ventilator management may more accurately reflect underlying lung injury and outperform traditional measures of readiness for ventilator liberation.
Details
- Title: Subtitle
- Plasma Soluble Suppression of Tumorigenicity-2 Associates with Ventilator Liberation in Acute Hypoxemic Respiratory Failure
- Creators
- Jehan Alladina - Massachusetts General HospitalSean D. Levy - Beth Israel Deaconess Medical CenterJosalyn L. Cho - Roy J. and Lucille A. Carver College of MedicineKelsey L. Brait - Massachusetts General HospitalSowmya R. Rao - Boston UniversityAlexander Camacho - Massachusetts General HospitalKathryn A. Hibbert - Massachusetts General HospitalR. Scott Harris - Massachusetts General HospitalBenjamin D. Medoff - Massachusetts General HospitalJames L. Januzzi - Massachusetts General HospitalB. Taylor Thompson - Massachusetts General HospitalEdnan K. Bajwa - Massachusetts General Hospital
- Resource Type
- Journal article
- Publication Details
- American journal of respiratory and critical care medicine, Vol.203(10), pp.1257-1265
- Publisher
- Amer Thoracic Soc
- DOI
- 10.1164/rccm.202005-1951OC
- PMID
- 33400890
- PMCID
- PMC8456472
- ISSN
- 1073-449X
- eISSN
- 1535-4970
- Number of pages
- 9
- Grant note
- R01 HL119344; T32 HL116275 / NIH; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA
- Language
- English
- Date published
- 05/15/2021
- Academic Unit
- Pulmonary, Critical Care, and Occupational Medicine; Internal Medicine
- Record Identifier
- 9984359878602771
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