Development and practical use of predictive methods of adult respiratory distress syndrome in patients with sepsis

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Adult respiratory distress syndrome (ARDS) can develop as a complication of various disorders, including sepsis, but it has not been possible to identify which of the patients at risk will develop serious disorfer. We have established a more rapid and easy method to measure serum levels of manganese superoxide dismutase than before and investigated the ability of six markers, measured sequentially in blood, to predict development of ARDS in patients with sepsis.At the initial diagnosis of sepsis (6-24h before the development of ARDS), serum manganese superoxide dismutase concentration and catalase activity were higher in the 6 patients who subsequently developed ARDS than in patients who did not develop ARDS.These changes in antioxidant enzymes predicted the development of ARDS in septic patients with the same sensitivity, specificity, and efficiency as simultaneous assessments of serum lactate dehydrogenase activity and factor VIII concentration. By contrast, serum glutathione peroxidase activity and alpha Pi-elastase complex concentration did not differ at the initial diagnosis of sepsis between patients who did and did not subsequently develop ARDS,and were not as effective in predicting the development of ARDS.Measurement of manganese superoxide dismutase, in addition to the other markers, should facilitate identification of patients at highest risk of ARDS and allow prospective treatment.