Plasma sRAGE is independently associated with increased mortality in ARDS: a meta-analysis of individual patient data.
Plasma sRAGE is independently associated with increased mortality in ARDS: a meta-analysis of individual patient data.
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DOI：
10.1007/s00134-018-5327-1
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发表时间：
2018-09
影响因子：
38.9
通讯作者：
Calfee CS
中科院分区：
文献类型：
--
作者：
Jabaudon M;Blondonnet R;Pereira B;Cartin-Ceba R;Lichtenstern C;Mauri T;Determann RM;Drabek T;Hubmayr RD;Gajic O;Uhle F;Coppadoro A;Pesenti A;Schultz MJ;Ranieri MV;Brodska H;Mrozek S;Sapin V;Matthay MA;Constantin JM;Calfee CS
晚期糖基化终产物可溶性受体（soluble receptor for advanced glycation end-products，sCRP）是肺上皮损伤和肺泡液体清除率（alveolar fluid clearance，AFC）的标志物，对急性呼吸窘迫综合征（acute respiratory distress syndrome，ARDS）的预后和肺损伤程度的评估具有重要价值。由于AFC在大多数ARDS患者中受损，并与较高的死亡率相关，我们假设基线血浆肌酐可预测死亡率，而与呼吸机诱导的肺损伤的两种关键介质无关。我们对入组8项前瞻性随机和观察性研究的746例患者的个体数据进行了荟萃分析，这些研究在截至2016年3月发表的ARDS文章中测量了血浆sodium。主要结局是90天死亡率。使用多变量和中介分析，我们检验了基线血浆肌酐和死亡率之间的关系，独立于驱动压和潮气量。较高的基线血浆胰岛素水平[每个1个对数增量的比值比（OR）为1.18; 95%置信区间（CI）为1.01-1.38; P = 0.04]，驱动压力（每增加一点的OR为1.04; 95% CI 1.02-1.07; P = 0.002），潮气量多变量分析显示，每1个对数增量的OR为1.98; 95%CI为1.07-3.64; P = 0.03）与90天死亡率较高独立相关。基线血浆肌酐介导较高ΔP对死亡率的一小部分影响，但不介导较高VT的影响。在ARDS患者中，较高的基线血浆胆红素与较高的90天死亡率相关，与驱动压和潮气量无关，因此加强了肺泡上皮损伤作为ARDS重要预后因素的可能作用。注册号：PROSPERO（ID：CRD 42018100241）。本文的在线版本（10.1007/s 00134 -018-5327-1）包含补充材料，可供授权用户使用。
The soluble receptor for advanced glycation end-products (sRAGE) is a marker of lung epithelial injury and alveolar fluid clearance (AFC), with promising values for assessing prognosis and lung injury severity in acute respiratory distress syndrome (ARDS). Because AFC is impaired in most patients with ARDS and is associated with higher mortality, we hypothesized that baseline plasma sRAGE would predict mortality, independently of two key mediators of ventilator-induced lung injury. We conducted a meta-analysis of individual data from 746 patients enrolled in eight prospective randomized and observational studies in which plasma sRAGE was measured in ARDS articles published through March 2016. The primary outcome was 90-day mortality. Using multivariate and mediation analyses, we tested the association between baseline plasma sRAGE and mortality, independently of driving pressure and tidal volume. Higher baseline plasma sRAGE [odds ratio (OR) for each one-log increment, 1.18; 95% confidence interval (CI) 1.01–1.38; P = 0.04], driving pressure (OR for each one-point increment, 1.04; 95% CI 1.02–1.07; P = 0.002), and tidal volume (OR for each one-log increment, 1.98; 95% CI 1.07–3.64; P = 0.03) were independently associated with higher 90-day mortality in multivariate analysis. Baseline plasma sRAGE mediated a small fraction of the effect of higher ΔP on mortality but not that of higher VT. Higher baseline plasma sRAGE was associated with higher 90-day mortality in patients with ARDS, independently of driving pressure and tidal volume, thus reinforcing the likely contribution of alveolar epithelial injury as an important prognostic factor in ARDS. Registration: PROSPERO (ID: CRD42018100241). The online version of this article (10.1007/s00134-018-5327-1) contains supplementary material, which is available to authorized users.
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影响因子：
9.6
作者：
Briot R;Frank JA;Uchida T;Lee JW;Calfee CS;Matthay MA
通讯作者：
Matthay MA
影响因子：
76.2
作者：
Calfee, Carolyn S.;Delucchi, Kevin;Parsons, Polly E.;Thompson, B. Taylor;Ware, Lorraine B.;Matthay, Michael A.
通讯作者：
Matthay, Michael A.
DOI：
10.1164/rccm.201603-0645oc
发表时间：
2017-02-01
影响因子：
24.7
作者：
Famous, Katie R.;Delucchi, Kevin;Calfee, Carolyn S.
通讯作者：
Calfee, Carolyn S.
影响因子：
120.7
作者：
Cavalcanti, Alexandre Biasi;Suzumura, Erica Aranha;Ribeiro de Carvalho, Carlos Roberto
通讯作者：
Ribeiro de Carvalho, Carlos Roberto
影响因子：
38.9
作者：
Gattinoni, L;Pesenti, A
通讯作者：
Pesenti, A