Outcome value of Clara cell protein in serum of patients with acute respiratory distress syndrome.
OBJECTIVE
Injury to the alveolocapillary barrier characterizes ALI/ARDS; therefore determining levels of lung epithelium-specific small proteins in serum may help predict clinical outcomes. We examined whether serum Clara cell protein (CC-16) concentration is correlated with the outcome, mechanical ventilation duration, and incidence of nonpulmonary organ failure.


METHODS
Prospective multicenter observational study conducted by the Quebec Critical Care Network.


METHODS
Seventy-eight adult ARDS patients requiring mechanical ventilation were enrolled and 28-day mortality was the primary outcome. Ventilatory parameters were computed and blood was sampled daily. Clinical information collected included cause of death, duration of mechanical ventilation, number of ventilator-free days, and organ failures.


RESULTS
Median serum levels of CC-16 were significantly higher in nonsurvivors than survivors on days 0-2 (19.93 microg/l, IQR 11.8-44.32, vs. 8.9, 5.66-26.38) and sustained up to day 14. CC-16 levels were correlated positively with the number of failing organs (rho 0.3623) and requirement for prolonged mechanical ventilation. Predictors of patient mortality included age, arterial carbon dioxide partial pressure, CC-16, and APACHE II score (odds ratios 1.35, 1.52, 1.37, 1.159, respectively).


CONCLUSIONS
Higher initial CC-16 serum level is associated with increased risk of death, fewer ventilator-free days, and increased frequency of nonpulmonary multiple organ failure. CC-16 is a valuable biomarker of ARDS that may help predict outcome among ARDS patients with high-risk mortality.
Lesur
Olivier
O
Groupe de Recherche en Physiopathologie Respiratoire, Centre de Recherche Clinique, Centre Hospitalier Universitaire de Sherbrooke 3001, 12 Avenue Nord, Sherbrooke, Canada. Olivier.Lesur@USherbrooke.ca
Langevin
Stephan
S
Berthiaume
Yves
Y
Légaré
Martin
M
Skrobik
Yoanna
Y
Bellemare
Jean-François
JF
Lévy
Bruno
B
Fortier
Yvan
Y
Lauzier
Francois
F
Bravo
Gina
G
Nickmilder
Marc
M
Rousseau
Eric
E
Bernard
Alfred
A
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000097:blood* / Q000401:mortality / Q000628:therapy; D014598:Uteroglobin / Q000097:blood*
C556389:SCGB1A1 protein, human; D014598:Uteroglobin