Surfactant Protein D Is Associated With Severe Pediatric ARDS, Prolonged Ventilation, and Death in Children With Acute Respiratory Failure
Surfactant Protein D Is Associated With Severe Pediatric ARDS, Prolonged Ventilation, and Death in Children With Acute Respiratory Failure
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DOI：
10.1016/j.chest.2020.03.041
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发表时间：
2020-09-01
期刊：
影响因子：
9.6
通讯作者：
Quasney, Michael W.
中科院分区：
文献类型：
--
作者：
Dahmer, Mary K.;Flori, Heidi;Quasney, Michael W.
背景：表面活性剂蛋白D （SP-D）升高是肺损伤的一个相对特异性指标，与成人急性和慢性肺部疾病以及早产儿呼吸窘迫综合征有关。急性呼吸衰竭患儿血浆SP-D与肺损伤的关系尚不清楚。研究问题：血浆SP-D是否与急性呼吸衰竭患儿的肺损伤或预后相关？研究设计和方法：这是一项前瞻性队列研究，研究对象为参加BALI多中心研究的2周至17岁急性呼吸衰竭儿童。在插管当天或随后2天中的某一天，使用第一个样本的血浆中SP-D水平进行分析。酶联免疫吸附法测定SP-D水平。结果：350例患者的血浆样本被用于分析；233例患有小儿ARDS （PARDS）。SP-D水平在原发性诊断中存在差异（P < 0.001）。在调整了年龄、儿童死亡风险III （PRISM-III）和初次诊断后，SP-D水平升高与严重PARDS相关（OR = 1.02; CI = 1.01-1.04; P = 0.011）。多变量分析还表明，SP-D水平升高与死亡（OR = 1.02; CI = 1.01-1.04; P = 0.004）、机械通气时间（P = 0.012）、PICU住院时间（P = 0.019）和最高氧合指数（P = 0.040）相关。SP-D水平也与年龄相关（rs = 0.16, P = 0.002）。结论：血浆SP-D水平升高与急性呼吸衰竭患儿严重PARDS和预后不良相关。未来的研究将确定SP-D是否可以用于预测肺损伤程度或对治疗的反应，以及SP-D是否有助于识别PARDS内源性类型。
BACKGROUND: Elevated surfactant protein D (SP-D) is a relatively specific indicator of lung injury and is associated with both acute and chronic lung disease in adults and respiratory distress syndrome in premature infants. The relationship between plasma SP-D and lung injury in children with acute respiratory failure is unclear.RESEARCH QUESTION: Is plasma SP-D associated with lung injury or outcome in children with acute respiratory failure?STUDY DESIGN AND METHODS: This was a prospective cohort study in children 2 weeks to 17 years of age with acute respiratory failure who participated in the BALI multi-center study. Analyses were done using SP-D levels in plasma from the first sample taken on either the day of intubation or one of the following 2 days. SP-D level was measured by enzyme-linked immunosorbent assay.RESULTS: Plasma samples from 350 patients were used in the analysis; 233 had pediatric ARDS (PARDS). SP-D levels varied across primary diagnoses (P < .001). Elevated SP-D levels were associated with severe PARDS after adjusting for age, pediatric risk of mortality III (PRISM-III), and primary diagnosis (OR = 1.02; CI = 1.01-1.04; P = .011). Multi variable analyses also indicated that elevated SP-D levels were associated with death (OR = 1.02; CI = 1.01-1.04; P = .004), duration of mechanical ventilation (P = .012), PICU length of stay (P = .019), and highest oxygenation index (P = .040). SP-D levels also correlated with age (rs = 0.16, P = .002).INTERPRETATION: Elevated plasma SP-D levels are associated with severe PARDS and poor outcomes in children with acute respiratory failure. Future studies will determine whether SP-D can be used to predict the degree of lung injury or response to treatment and whether SP-D is useful in identifying PARDS endotypes.