title: Plasma angiopoietin-2 predicts the onset of acute lung injury in critically ill patients.
abstract: BACKGROUND
  Current clinical prediction scores for acute lung injury (ALI) have limited positive predictive value. No studies have evaluated predictive plasma biomarkers in a broad population of critically ill patients or as an adjunct to clinical prediction scores.
  
  
  OBJECTIVE
  To determine whether plasma angiopoietin-2 (Ang-2), von Willebrand factor (vWF), interleukin-8 (IL-8), and/or receptor for advanced glycation end products (sRAGE) predict ALI in critically ill patients.
  
  
  METHODS
  Plasma samples were drawn from critically ill patients (n = 230) identified in the emergency department. Patients who had ALI at baseline or in the subsequent 6 hours were excluded, and the remaining patients were followed for development of ALI.
  
  
  RESULTS
  Nineteen patients developed ALI at least 6 hours after the sample draw. Higher levels of Ang-2 and IL-8 were significantly associated with increased development of ALI (P = 0.0008, 0.004, respectively). The association between Ang-2 and subsequent development of ALI was robust to adjustment for sepsis and vasopressor use. Ang-2 and the Lung Injury Prediction Score each independently discriminated well between those who developed ALI and those who did not (area under the receiver operating characteristic curve, 0.74 for each), and using the two together improved the area under the curve to 0.84 (vs. 0.74, P = 0.05). In contrast, plasma levels of sRAGE and vWF were not predictive of ALI.
  
  
  CONCLUSIONS
  Plasma biomarkers such as Ang-2 can improve clinical prediction scores and identify patients at high risk for ALI. In addition, the early rise of Ang-2 emphasizes the importance of endothelial injury in the early pathogenesis of ALI.
authors: School of Medicine, University of California-San Francisco, CA 94143, USA.
authors: Ashish
authors: A
authors: Agrawal
authors: Michael A
authors: MA
authors: Matthay
authors: Kirsten N
authors: KN
authors: Kangelaris
authors: John
authors: J
authors: Stein
authors: Jeffrey C
authors: JC
authors: Chu
authors: Brandon M
authors: BM
authors: Imp
authors: Alfredo
authors: A
authors: Cortez
authors: Jason
authors: J
authors: Abbott
authors: Kathleen D
authors: KD
authors: Liu
authors: Carolyn S
authors: CS
authors: Calfee
mesh_terms: D055371:Acute Lung Injury / Q000097:blood* / Q000503:physiopathology; D000368:Aged; D000369:Aged, 80 and over; D042702:Angiopoietin-2 / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D016638:Critical Illness; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D016209:Interleukin-8 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D000067759:Receptor for Advanced Glycation End Products; D011971:Receptors, Immunologic / Q000097:blood*; D012044:Regression Analysis; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014841:von Willebrand Factor / Q000032:analysis*
chemical_list: D042702:Angiopoietin-2; D015415:Biomarkers; D016209:Interleukin-8; D000067759:Receptor for Advanced Glycation End Products; D011971:Receptors, Immunologic; D014841:von Willebrand Factor