title: Type III procollagen is a reliable marker of ARDS-associated lung fibroproliferation.
abstract: OBJECTIVE
  A specific biomarker of post-ARDS fibroproliferation could be useful in the identification of patients who could benefit from therapies aiming to modulate fibroproliferation such as corticosteroids.The aim of this prospective study was to determine the best threshold of the N-terminal-peptidetype III procollagen (NT-PCP-III) in non-resolving ARDS to validate this threshold according to the outcome.
  
  
  METHODS
  Concerning the best threshold of NT-PCP-III, all consecutive patients with a non-resolving ARDS were included if all the following criteria were fulfilled: moderate to severe ARDS lasting for at least 5 days, lung biopsy performed, serum and alveolar NT-PCP-III obtained within 1 week prior to biopsy, and no documented infection contra-indicating the corticosteroids. In the validation cohort part of the study, patients were included at day 7 if they presented a persistent moderate to severe ARDS.
  
  
  RESULTS
  Nineteen of 32 patients had fibroproliferatio nonbiopsy. Serum and alveolar NT-PCP-III were higher in patients with fibroproliferation. Using a threshold of 9 µg/L, alveolar NT-PCP-III had the highest accuracy for diagnosing fibroproliferation (sensitivity = 89.5 % and specificity = 92.3 %). Regarding the 51 patients included in the validation cohort, the mortality rate at day 60 was increased in patients presenting an alveolar NT-PCP-III level higher than 9 µg/L (69 vs. 17 %, p < 0.001). The mean alveolar level of NT-PCP-III on day 7 was 8.1-fold higher in nonsurvivors (p = 0.03).
  
  
  CONCLUSIONS
  The determination of NT-PCP-III on BAL done at day 7 in persistent ARDS is able to identify patients with fibroproliferation who could be included in a trial of corticosteroids or any other treatment that might help resolve lung fibroproliferation.
authors.affiliation: Faculté de Médecine, Aix-Marseille Université, URMITE UMR CNRS 7278, 13005, Marseille, France, jean-marie.forel@ap-hm.fr.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Forel
authors.forename: Christophe
authors.initials: C
authors.lastname: Guervilly
authors.forename: Sami
authors.initials: S
authors.lastname: Hraiech
authors.forename: François
authors.initials: F
authors.lastname: Voillet
authors.forename: Guillemette
authors.initials: G
authors.lastname: Thomas
authors.forename: Claude
authors.initials: C
authors.lastname: Somma
authors.forename: Véronique
authors.initials: V
authors.lastname: Secq
authors.forename: Catherine
authors.initials: C
authors.lastname: Farnarier
authors.forename: Marie-Josée
authors.initials: MJ
authors.lastname: Payan
authors.forename: Stéphanie-Yannis
authors.initials: SY
authors.lastname: Donati
authors.forename: Gilles
authors.initials: G
authors.lastname: Perrin
authors.forename: Delphine
authors.initials: D
authors.lastname: Trousse
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Dizier
authors.forename: Laurent
authors.initials: L
authors.lastname: Chiche
authors.forename: Karine
authors.initials: K
authors.lastname: Baumstarck
authors.forename: Antoine
authors.initials: A
authors.lastname: Roch
authors.forename: Laurent
authors.initials: L
authors.lastname: Papazian
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D001706:Biopsy; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry; D024061:Collagen Type III / Q000378:metabolism*; D005260:Female; D005347:Fibroblasts / Q000473:pathology; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011658:Pulmonary Fibrosis / Q000188:drug therapy* / Q000209:etiology* / Q000378:metabolism; D012128:Respiratory Distress Syndrome / Q000150:complications* / Q000378:metabolism
chemical_list: D015415:Biomarkers; D024061:Collagen Type III; D005938:Glucocorticoids