title: Predictors of response to corticosteroid treatment in patients with early acute respiratory distress syndrome: results of a pilot study.
abstract: Prospective observational cohort study was performed to evaluate predictors for responsiveness to corticosteroid treatment in patients with acute respiratory distress syndrome (ARDS). Over the study period, a total of 20 patients (male 70%, median age 69) with ARDS were treated with corticosteroid within 72 h after intubation. The median lung injury score (LIS) and partial pressure of arterial oxygen (PaO₂)/fraction of inspired oxygen (FiO₂) ratios (PF ratios) were 3.0 (interquartile range, 2.7-3.0) and 146.6 (119.9-179.4), respectively. The median levels of triggering receptor expressed on myeloid cells (TREM-1) and procollagen peptide type III in bronchoalveolar lavage (BAL) fluid were 349.3 (225.6-634.9) pg/mL and 19.6 (11.7-39.7) pg/mL, respectively. After 7 days of corticosteroid treatment, 10 (50%) patients showed response to the treatment (successful extubation in 7 and 1-point or more reduction in LIS in 3). Compared to non-responders, responders had higher initial PF ratios (170.5 vs. 127.2, p=0.023), lower level of TREM-1 in BAL fluid (313.6 pg/mL vs. 520.5 pg/mL, p=0.029), and greater reduction in LIS at 3 days (-1 vs. 0, p<0.001). In conclusion, PF ratios and TREM-1 level in BAL fluid at baseline, and reduction in LIS at day 3 after the treatment were associated with the response to prolonged corticosteroid treatment (ClinicalTrials.gov Identifier: NCT01093287).
authors.affiliation: Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Kyeongman
authors.initials: K
authors.lastname: Jeon
authors.affiliation: Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Chi Ryang
authors.initials: CR
authors.lastname: Chung
authors.affiliation: Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.; Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Jeong Hoon
authors.initials: JH
authors.lastname: Yang
authors.affiliation: Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.; Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Chi Min
authors.initials: CM
authors.lastname: Park
authors.affiliation: Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. suhgy@skku.edu.
authors.forename: Gee Young
authors.initials: GY
authors.lastname: Suh
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012128:Respiratory Distress Syndrome / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones
keywords: Acute respiratory distress syndrome; glucocorticoids; organ dysfunction scores; risk factors