title: Sepsis-induced acute respiratory distress syndrome with fatal outcome is associated to increased serum transforming growth factor beta-1 levels.
abstract: BACKGROUND
  TGF-β1 is a promoter of pulmonary fibrosis in many chronic inflammatory diseases. TGF-β1 circulating levels in patients with sepsis-induced Acute Respiratory Distress Syndrome (ARDS) have not been established.
  
  
  METHODS
  In this prospective pilot cohort study, serum bioactive TGF-β1 concentration, determined by sandwich ELISA, was analyzed in 52 patients who fulfilled criteria for septic shock at admission and on days 3 and 7.
  
  
  RESULTS
  Of the 52 patients enrolled in the study, 46.1% fulfilled the criteria for ARDS on admission. At ICU admission, there were not statistical differences in TGF-β1 concentrations between septic shock patients with or without ARDS. After 7 days of follow-up in ICU, circulating TGF-β1 levels were significantly higher in patients with sepsis and ARDS than in those without ARDS [55.47 (35.04-79.48 pg/ml) versus 31.65 (22.89-45.63 pg/ml), respectively] (p = 0.002). Furthermore, in septic shock associated ARDS patients, TGF-β1 levels were significantly higher in nonsurvivors than in survivors [85.23 (78.19-96.30 pg/ml) versus 36.41 (30.21-55.47 pg/ml), respectively] (p = 0.006) on day 7 of ICU follow-up.
  
  
  CONCLUSIONS
  In patients with septic shock, persistent ARDS is accompanied with increased circulating TGF-β1 levels. Furthermore, ARDS patients with fatal outcome show higher TGF-β1 concentrations than survivors. These results suggest the relevance of TGF-β1 levels found in the pathogenesis of persistent sepsis-induced ARDS.
authors.affiliation: Intensive Care Unit, Hospital Universitario Príncipe de Asturias, Department of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain. raul.depablo@uah.es
authors.forename: Raúl
authors.initials: R
authors.lastname: de Pablo
authors.forename: Jorge
authors.initials: J
authors.lastname: Monserrat
authors.forename: Eduardo
authors.initials: E
authors.lastname: Reyes
authors.forename: David
authors.initials: D
authors.lastname: Díaz
authors.forename: Manuel
authors.initials: M
authors.lastname: Rodríguez-Zapata
authors.forename: Antonio de
authors.initials: Ad
authors.lastname: la Hera
authors.forename: Alfredo
authors.initials: A
authors.lastname: Prieto
authors.forename: Melchor
authors.initials: M
authors.lastname: Alvarez-Mon
mesh_terms: D000328:Adult; D000368:Aged; D018450:Disease Progression; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000097:blood* / Q000209:etiology / Q000401:mortality; D012772:Shock, Septic / Q000097:blood / Q000150:complications / Q000401:mortality; D053773:Transforming Growth Factor beta1 / Q000097:blood*
chemical_list: D053773:Transforming Growth Factor beta1