title: Serial inflammatory biomarkers of the severity, course and outcome of late onset acute respiratory distress syndrome in critically ill patients with or at risk for the syndrome after new-onset fever.
abstract: OBJECTIVE
  Accurate biomarkers of the acute respiratory distress syndrome (ARDS) may help risk stratification and management. We assessed the relation between several biomarkers and the severity, course and outcome of late onset ARDS in 101 consecutive critically ill patients with new onset fever.
  
  
  METHODS
  On study days 0, 1, 2 and 7 we measured angiopoietin-2 (ANG2), pentraxin-3 (PTX3), interleukin-6 (IL-6), procalcitonin (PCT) and midregional proadrenomedullin (proADM). ARDS was defined by the Berlin definition and by the lung injury score (LIS).
  
  
  RESULTS
  At baseline, 48% had ARDS according to the Berlin definition and 86% according to the LIS. Baseline markers poorly predicted maximum Berlin categories attained within 7 days, whereas ANG2 best predicted maximum LIS. Depending on the ARDS definition, the day-by-day area under the receiver operating characteristic curves suggested greatest monitoring value for IL-6 and PCT, followed by ANG2. ANG2 and proADM predicted outcome, independently of disease severity.
  
  
  CONCLUSIONS
  Whereas IL-6 and PCT had some disease monitoring value, ANG2 was the only biomarker capable of both predicting the severity, monitoring the course and predicting the outcome of late onset ARDS in febrile critically ill patients, irrespective of underlying risk factor, thereby yielding the most specific ARDS biomarker among those studied.
authors.affiliation: Department of intensive care of Erasmus Medical Centre Rotterdam, s-Gravendijkwal 230; 3015 CE Rotterdam, The Netherlands.|Department of intensive care of VU University Medical Centre Amsterdam, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands.
authors.forename: Sandra H
authors.initials: SH
authors.lastname: Hoeboer
authors.affiliation: Department of intensive care of Erasmus Medical Centre Rotterdam, s-Gravendijkwal 230; 3015 CE Rotterdam, The Netherlands.
authors.forename: A B Johan
authors.initials: AB
authors.lastname: Groeneveld
authors.affiliation: Department of intensive care of Erasmus Medical Centre Rotterdam, s-Gravendijkwal 230; 3015 CE Rotterdam, The Netherlands.|Department of physiology of VU University Medical Centre Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
authors.forename: Melanie
authors.initials: M
authors.lastname: van der Heijden
authors.affiliation: Department of intensive care of VU University Medical Centre Amsterdam, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands.
authors.forename: Heleen M
authors.initials: HM
authors.lastname: Oudemans-van Straaten
mesh_terms: D053607:Adrenomedullin / Q000097:blood*; D000328:Adult; D000368:Aged; D042702:Angiopoietin-2 / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D016638:Critical Illness; D005260:Female; D005334:Fever / Q000097:blood*; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D055370:Lung Injury / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011498:Protein Precursors / Q000097:blood*; D012128:Respiratory Distress Syndrome / Q000097:blood*; D000683:Serum Amyloid P-Component / Q000378:metabolism; D012720:Severity of Illness Index; D000099153:Pentraxins
chemical_list: D053607:Adrenomedullin; D042702:Angiopoietin-2; D015415:Biomarkers; D002097:C-Reactive Protein; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide; D015850:Interleukin-6; D011498:Protein Precursors; D000683:Serum Amyloid P-Component; D000099153:Pentraxins; C586513:ANGPT2 protein, human; C000606589:CALCA protein, human; C508600:IL6 protein, human; C088633:proadrenomedullin
keywords: acute respiratory distress syndrome; angiopoietin-2; biomarkers; febrile critical illness; prediction; procalcitonin; severity and course