title: Plasma Adiponectin, clinical factors, and patient outcomes during the acute respiratory distress syndrome.
abstract: OBJECTIVE
  Adiponectin (APN) is an anti-inflammatory hormone derived from adipose tissue that attenuates acute lung injury in rodents. In this study, we investigated the association between circulating APN and outcomes among patients with acute respiratory distress syndrome (ARDS).
  
  
  METHODS
  We performed a retrospective cohort study using data and plasma samples from participants in the multicenter ARDS Network Fluid and Catheter Treatment Trial.
  
  
  RESULTS
  Plasma APN concentrations were measured in 816 (81.6%) trial participants at baseline and in 568 (56.8%) subjects at both baseline and day 7 after enrollment. Clinical factors associated with baseline APN levels in multivariable-adjusted models included sex, body mass index, past medical history of cirrhosis, and central venous pressure (model R2 = 9.7%). We did not observe an association between baseline APN and either severity of illness (APACHE III) or extent of lung injury (Lung Injury Score). Among patients who received right heart catheterization (n = 384), baseline APN was inversely related to mean pulmonary artery pressure (β = -0.015, R2 1.5%, p = 0.02); however, this association did not persist in multivariable models (β = -0.009, R2 0.5%, p = 0.20). Neither baseline APN levels [HR per quartile1.04 (95% CI 0.91-1.18), p = 0.61], nor change in APN level from baseline to day 7 [HR 1.04 (95% CI 0.89-1.23), p = 0.62)] were associated with 60 day mortality in Cox proportional hazards regression models. However, subgroup analysis identified an association between APN and mortality among patients who developed ARDS from extra-pulmonary etiologies [HR per quartile 1.31 (95% CI 1.08-1.57)]. APN levels did not correlate with mortality among patients developing ARDS in association with direct pulmonary injury [HR 0.96 (95% CI 0.83-1.13)], pinteraction = 0.016.
  
  
  CONCLUSIONS
  Plasma APN levels did not correlate with disease severity or mortality in a large cohort of patients with ARDS. However, higher APN levels were associated with increased mortality among patients developing ARDS from extra-pulmonary etiologies.
authors.affiliation: The Pulmonary Center, Boston University School of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Boston Medical Center, Boston, Massachusetts, United States of America.
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Walkey
authors.affiliation: Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Serkalem
authors.initials: S
authors.lastname: Demissie
authors.affiliation: Center for Translational Medicine and Korman Lung Center, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America.
authors.forename: Dilip
authors.initials: D
authors.lastname: Shah
authors.affiliation: Center for Translational Medicine and Korman Lung Center, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America.
authors.forename: Freddy
authors.initials: F
authors.lastname: Romero
authors.affiliation: Center for Translational Medicine and Korman Lung Center, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America.
authors.forename: Leah
authors.initials: L
authors.lastname: Puklin
authors.affiliation: Center for Translational Medicine and Korman Lung Center, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America.
authors.forename: Ross S
authors.initials: RS
authors.lastname: Summer
mesh_terms: D018806:APACHE; D052242:Adiponectin / Q000097:blood*; D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012128:Respiratory Distress Syndrome / Q000097:blood* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D052242:Adiponectin