title: The predictive role of serum and bronchoalveolar lavage cytokines and adhesion molecules for acute respiratory distress syndrome development and outcome.
abstract: BACKGROUND
  The predictive role of many cytokines and adhesion molecules has not been studied systematically in acute respiratory distress syndrome (ARDS).
  
  
  METHODS
  We measured prospectively tumour necrosis factor alpha (TNF-alpha), interleukin (IL)-1, soluble vascular adhesion molecule-1 (VCAM-1) and soluble intercellular adhesion molecule-1 (ICAM-1) in serum and bronchoalveolar lavage fluid (BALF) within 2 hours following admission, in 65 patients. The patients were divided into: those fulfilling the criteria for ARDS (n = 23, group A), those who were pre-ARDS and who developed ARDS within 24 hours (n = 14, group B), and those on pre-ARDS but who never developed ARDS (n = 28, group C).
  
  
  RESULTS
  All the measured molecules were only found at higher levels in the serum of patients that died either with or without ARDS (P < 0.05 - P < 0.0001). Patients at risk exhibited a good negative predictive value (NPV) of the measured molecules for ARDS development both in their serum (89 to 95%) and BALF (86 to 92%) levels. In contrast to BALF, serum levels of IL-1 and adhesion molecules exhibited a good NPV (68 to 96%), sensitivity (60 to 88%) and survival specificity (74 to 96%) in all groups. All molecules in serum and BALF IL-1 were correlated with the APACHE II (P < 0.05 - P < 0.0001). Serum and BALF IL-1 as well as BALF TNF-alpha were negatively correlated to PaO2/FiO2 (all P < 0.05).
  
  
  CONCLUSIONS
  The studied molecules have good NPV for ARDS development both in serum and BALF. Serum rather than BALF levels seem to be related to outcome.
authors.affiliation: Intensive Care Unit, General Hospital of Rethymnon, Crete, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Agouridakis
authors.forename: Despina
authors.initials: D
authors.lastname: Kyriakou
authors.forename: Michael G
authors.initials: MG
authors.lastname: Alexandrakis
authors.forename: Athanasios
authors.initials: A
authors.lastname: Prekates
authors.forename: Kostas
authors.initials: K
authors.lastname: Perisinakis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Karkavitsas
authors.forename: Demosthenes
authors.initials: D
authors.lastname: Bouros
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D018893:Bronchoalveolar Lavage / Q000379:methods; D001992:Bronchoalveolar Lavage Fluid; D015815:Cell Adhesion Molecules / Q000097:blood* / Q000378:metabolism; D016207:Cytokines / Q000097:blood* / Q000378:metabolism; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000097:blood* / Q000209:etiology* / Q000378:metabolism / Q000401:mortality
chemical_list: D015815:Cell Adhesion Molecules; D016207:Cytokines