High levels of circulating leukocyte microparticles are associated with better outcome in acute respiratory distress syndrome.
BACKGROUND
The current study has addressed the presence and the cellular origin of microparticles (MP) isolated from bronchoalveolar lavage (BAL) fluid and from blood samples from patients with acute respiratory distress syndrome (ARDS). Their prognostic interest was also investigated.


METHODS
Fifty-two patients were included within the first 24 hours of ARDS. They were compared to spontaneous breathing (SB) and ventilated control (VC) groups. Bronchoalveolar lavage (BAL) and blood samples were obtained on Day 1 and Day 3 in an ARDS group. Leukocyte microparticles (LeuMP), neutrophil microparticles (NeuMP), endothelial microparticles (EMP), and platelet microparticles (PMP) were measured in arterial blood and in BAL samples by flow cytometry. Mortality from all causes was recorded at Day 28.


RESULTS
All MP subpopulations were detected in BAL. However, only LeuMP and NeuMP were elevated in ARDS patients compared to the SB group (P = 0.002 for both). Among ARDS patients, higher levels of LeuMP were detected in blood (Day 1) and in BAL (Day 3) in survivors as compared with the non survivors. Circulating LeuMP >60 elements/microliter detectable on Day 1 of ARDS, was associated with a higher survival rate (odds ratio, 5.26; 95% confidence interval, 1.10 to 24.99; P = 0.037).


CONCLUSIONS
The identification of the cellular origin of microparticles at the onset of ARDS has identified LeuMP as a biomarker of prognostic significance. The higher levels of LeuMP in survivors could be associated with a protective role of this MP subpopulation. This hypothesis needs further investigations.
Réanimation Médicale-Détresses Respiratoires Aigües-Infections Sévères, URMITE CNRS-UMR 6236, Hôpital Nord, Assistance Publique, Hôpitaux de Marseille, Chemin des Bourrely, 13015 Marseille, France. christophe.guervilly@ap-hm.fr
Christophe
C
Guervilly
Romaric
R
Lacroix
Jean-Marie
JM
Forel
Antoine
A
Roch
Laurence
L
Camoin-Jau
Laurent
L
Papazian
Françoise
F
Dignat-George
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood / Q000378:metabolism; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology*; D016022:Case-Control Studies; D055252:Cell-Derived Microparticles; D005260:Female; D006801:Humans; D007962:Leukocytes / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012128:Respiratory Distress Syndrome / Q000378:metabolism* / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome
D015415:Biomarkers
Am J Physiol Lung Cell Mol Physiol. 2009 Dec;297(6):L1035-41
19700643
Thromb Res. 2002 Nov 25;108(4):215-20
12617984
Blood. 2000 Feb 1;95(3):930-5
10648405
Am J Respir Crit Care Med. 2008 Dec 1;178(11):1148-55
18723433
N Engl J Med. 2000 May 4;342(18):1334-49
10793167
Blood. 2008 Sep 15;112(6):2512-9
18594025
Intensive Care Med. 2004 Jan;30(1):51-61
14569423
J Thromb Haemost. 2009 Jan;7(1):190-7
18983485
Am Rev Respir Dis. 1988 Sep;138(3):720-3
3202424
J Appl Physiol (1985). 1986 Feb;60(2):532-8
3512509
Arterioscler Thromb Vasc Biol. 2006 Dec;26(12):2594-604
16990554
Am J Transplant. 2009 Mar;9(3):550-7
19260834
JAMA. 1993 Dec 22-29;270(24):2957-63
8254858
J Trauma. 2008 Mar;64(3):698-704
18332810
N Engl J Med. 2003 Jan 9;348(2):138-50
12519925
N Engl J Med. 2002 Apr 25;346(17):1281-6
11973365
Crit Care Med. 2005 Nov;33(11):2540-6
16276178
Am J Respir Crit Care Med. 2001 Feb;163(2):316-21
11179099
Chest. 1998 Jun;113(6):1632-9
9631804
Chest. 1995 Nov;108(5):1303-14
7587434
Intern Med. 1996 Nov;35(11):855-60
8968796
Chest. 1992 Jun;101(6):1644-55
1303622
Am J Respir Crit Care Med. 1994 Mar;149(3 Pt 1):818-24
7509706
J Trauma. 2003 Jan;54(1):114-9; discussion 119-20
12544906
Am J Respir Crit Care Med. 2009 Feb 1;179(3):220-7
19011152
Intensive Care Med. 2007 Mar;33(3):444-7
17268795
Blood. 2004 Oct 15;104(8):2543-8
15213101
Intensive Care Med. 1996 Jul;22(7):707-10
8844239
J Trauma. 2004 Apr;56(4):823-30; discussion 830-1
15187749
JAMA. 2004 Jun 2;291(21):2542-4
15173142