title: Serial changes in surfactant-associated proteins in lung and serum before and after onset of ARDS.
abstract: The goal of this study was to determine the changes that occur in surfactant-associated proteins in bronchoalveolar lavage fluid (BAL) and serum of patients at risk for ARDS and during the course of ARDS. We found that the concentrations of SP-A and SP-B were low in the BAL of patients at risk for ARDS before the onset of clinically defined lung injury, whereas the concentration of SP-D was normal. In patients with established ARDS, BAL SP-A and SP-B concentrations were low during the entire 14-d observation period, but the median SP-D concentrations remained in the normal range. Immunoreactive SP-A and SP-D were not increased in the serum of patients at risk for ARDS, but both increased after the onset of ARDS to a maximum on Day 3 and remained elevated for as long as 14 d. The BAL SP-A concentrations were significantly lower in at-risk patients who developed ARDS, and no patient with a BAL SP-A concentration greater than 1.2 microg/ml developed ARDS. On Days 1 and 3 of ARDS, the BAL SP-D concentration was significantly lower in patients who died, and the BAL SP-D concentration was significantly related to the PI(O(2))/FI(O(2)) ratio. Thus, surfactant protein abnormalities occur before and after the onset of ARDS, and the responses of SP-A, SP-B, and SP-D differ in important ways. The BAL SP-A and SP-D measurements can be used to classify patients as high or low risk for progression to ARDS and/or death after the onset of ARDS. Strategies to increase these surfactant proteins in the lungs of patients with ARDS could be useful to modify the onset or the course of ARDS.
authors.affiliation: Harborview Medical Center, Seattle, Washington, USA.
authors.forename: K E
authors.initials: KE
authors.lastname: Greene
authors.forename: J R
authors.initials: JR
authors.lastname: Wright
authors.forename: K P
authors.initials: KP
authors.lastname: Steinberg
authors.forename: J T
authors.initials: JT
authors.lastname: Ruzinski
authors.forename: E
authors.initials: E
authors.lastname: Caldwell
authors.forename: W B
authors.initials: WB
authors.lastname: Wong
authors.forename: W
authors.initials: W
authors.lastname: Hull
authors.forename: J A
authors.initials: JA
authors.lastname: Whitsett
authors.forename: T
authors.initials: T
authors.lastname: Akino
authors.forename: Y
authors.initials: Y
authors.lastname: Kuroki
authors.forename: H
authors.initials: H
authors.lastname: Nagae
authors.forename: L D
authors.initials: LD
authors.lastname: Hudson
authors.forename: T R
authors.initials: TR
authors.lastname: Martin
mesh_terms: D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry; D006023:Glycoproteins / Q000378:metabolism; D006801:Humans; D008168:Lung / Q000378:metabolism*; D008875:Middle Aged; D011510:Proteolipids / Q000378:metabolism; D037662:Pulmonary Surfactant-Associated Protein A; D037663:Pulmonary Surfactant-Associated Protein D; D037661:Pulmonary Surfactant-Associated Proteins; D011663:Pulmonary Surfactants / Q000097:blood / Q000378:metabolism*; D012372:ROC Curve; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000378:metabolism*; D012307:Risk Factors; D018805:Sepsis / Q000150:complications; D014947:Wounds and Injuries / Q000150:complications
chemical_list: D006023:Glycoproteins; D011510:Proteolipids; D037662:Pulmonary Surfactant-Associated Protein A; D037663:Pulmonary Surfactant-Associated Protein D; D037661:Pulmonary Surfactant-Associated Proteins; D011663:Pulmonary Surfactants