title: Pre-B-cell colony-enhancing factor and its clinical correlates with acute lung injury and sepsis.
abstract: BACKGROUND
  Pre-B-cell colony-enhancing factor (PBEF) is a potential biomarker for acute lung injury (ALI) in sepsis. We aimed to determine the clinical correlates for elevated plasma PBEF upon ICU admission for severe sepsis and the usefulness of PBEF to predict ALI development and sepsis mortality.
  
  
  METHODS
  This is a prospective cohort of patients admitted to the medical ICU with severe sepsis. Patients without available blood samples or who were not enrolled within 24 h of admission were excluded. Plasma collected within 24 h of ICU admission was measured for PBEF concentrations by enzyme-linked immunosorbent assay. Patients were followed for ALI development as defined by the American-European Consensus Conference and for all-cause hospital mortality.
  
  
  RESULTS
  Between September 30, 2008, and March 10, 2009, 113 patients were enrolled, and 50 (44%) developed ALI. Elevated PBEF levels significantly correlated with higher APACHE (Acute Physiology and Chronic Health Evaluation) III scores (R(2) = 0.08, P = .003) and failure to reach early sepsis goals within 6 h of severe sepsis (P = .003). PBEF did not differ by ALI status (P = .58). The mortality rate was 46%. Nonsurvivors had higher PBEF levels than survivors (2.53 ng/mL; interquartile range [IQR], 1.07-8.16 vs 1.44 ng/mL; IQR, 0.84-2.81; P = .02). After adjusting for severity of illness, PBEF levels were no longer significantly associated with mortality (OR, 1.44 per 10-fold increase; 95% CI, 0.69-3.03, P = .34).
  
  
  CONCLUSIONS
  In this study, elevated PBEF did not correlate with lung injury in sepsis. However, it was associated with sepsis mortality mainly due to its association with greater severity of illness on ICU admission.
authors.affiliation: Department of Medicine, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Lee
authors.affiliation: Division of Critical Care Medicine, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY. Electronic address: MGong@montefiore.org.
authors.forename: Michelle N
authors.initials: MN
authors.lastname: Gong
mesh_terms: D018806:APACHE; D055371:Acute Lung Injury / Q000150:complications / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D054409:Nicotinamide Phosphoribosyltransferase / Q000097:blood*; D018805:Sepsis / Q000150:complications* / Q000175:diagnosis
chemical_list: D015415:Biomarkers; D054409:Nicotinamide Phosphoribosyltransferase