The clinical significance of serum and bronchoalveolar lavage inflammatory cytokines in patients at risk for Acute Respiratory Distress Syndrome.
BACKGROUND
The predictive role of many cytokines has not been well defined in Acute Respiratory Distress Syndrome (ARDS).


METHODS
We measured prospectively IL-4, IL-6, IL-6 receptor, IL-8, and IL-10, in the serum and bronchoalveolar lavage fluid (BALF) in 59 patients who were admitted to ICU in order to identify predictive factors for the course and outcome of ARDS. The patients were divided into three groups: those fulfilling the criteria for ARDS (n = 20, group A), those at risk for ARDS and developed ARDS within 48 hours (n = 12, group B), and those at risk for ARDS but never developed ARDS (n = 27, group C).


RESULTS
An excellent negative predictive value for ARDS development was found for IL-6 in BALF and serum (100% and 95%, respectively). IL-8 in BALF and IL-8 and IL-10 serum levels were higher in non-survivors in all studied groups, and were associated with a high negative predictive value. A significant correlation was found between IL-8 and APACHE score (r = 0.60, p < 0.0001). Similarly, IL-6 and IL-6r were highly correlated with PaO2/FiO2 (r = -0.27, p < 0.05 and r = -0.55, p < 0.0001, respectively).


CONCLUSIONS
BALF and serum levels of the studied cytokines on admission may provide valuable information for ARDS development in patients at risk, and outcome in patients either in ARDS or in at risk for ARDS.
Department of Pneumonology and Intensive Care Unit, University General Hospital of Alexandroupolis, Alexandroupolis, Greece. bouros@med.duth.gr
Demosthenes
D
Bouros
Michael G
MG
Alexandrakis
Katerina M
KM
Antoniou
Panagiotis
P
Agouridakis
Ioannis
I
Pneumatikos
Stavros
S
Anevlavis
Athanasia
A
Pataka
George
G
Patlakas
Nikolaos
N
Karkavitsas
Despina
D
Kyriakou