Circulating KL-6/MUC1 as an independent predictor for disseminated intravascular coagulation in acute respiratory distress syndrome.
OBJECTIVE
Acute respiratory distress syndrome (ARDS) patients show high levels of circulating mucin including KL-6/MUC1 (soluble MUC1 mucin). Because cancer mucin can bind vascular endothelial cells and platelets via selectins, mucin-selectin interactions are reported to trigger platelet aggregation and intravascular coagulation. Therefore, we hypothesized that KL-6/MUC1 is involved in the pathogenesis of disseminated intravascular coagulation (DIC) in ARDS. The aim of the current study is to evaluate the association between circulating KL-6/MUC1 and DIC in ARDS patients.


METHODS
Observational study with structured follow-up.


METHODS
Intensive care unit in Hiroshima University Hospital.


METHODS
Fifty-six newly diagnosed patients with ARDS.


METHODS
Circulating levels of KL-6/MUC1 were measured during diagnosis and serially measured during the clinical course along with indices of respiratory failure, inflammation, coagulation and fibrinolysis and multiple organ dysfunction.


RESULTS
Acute respiratory distress syndrome patients complicated with DIC showed significantly higher levels of serum KL-6/MUC1 than patients without DIC during the clinical course. Amongst the parameters analysed at diagnosis of ARDS, KL-6/MUC1 was an independent predictor for DIC complication. The baseline level of circulating KL-6/MUC1 at diagnosis of ARDS was significantly correlated with an increased DIC score following ARDS diagnosis. Using an optimum cutoff level of KL-6/MUC1 obtained by a receiver operating characteristic curve, the sensitivity and specificity for predicting future DIC development in ARDS patients were 88.9% and 55.3%, respectively.


CONCLUSIONS
These results suggest that KL-6/MUC1 is associated with DIC development in ARDS patients. Elevated levels of KL-6/MUC1 at diagnosis could be a predictor of DIC complication in ARDS.
Nakashima
T
T
Department of Molecular and Internal Medicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
Yokoyama
A
A
Ohnishi
H
H
Hamada
H
H
Ishikawa
N
N
Haruta
Y
Y
Hattori
N
N
Tanigawa
K
K
Kohno
N
N
D000368:Aged; D004211:Disseminated Intravascular Coagulation / Q000097:blood* / Q000235:genetics; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008168:Lung / Q000378:metabolism*; D055370:Lung Injury; D008297:Male; D018396:Mucin-1 / Q000097:blood* / Q000235:genetics; D011237:Predictive Value of Tests; D012128:Respiratory Distress Syndrome / Q000097:blood* / Q000150:complications; D012720:Severity of Illness Index
C060192:MUC1 protein, human; D018396:Mucin-1