Biomarkers in pediatric acute respiratory distress syndrome

Differential changes in expression of inflammatory mRNA and protein after oleic acid-induced acute lung injury

Background: Acute Respiratory Distress syndrome (ARDS) is a clinical syndrome of noncardiac pulmonary edema and inflammation leading to acute respiratory failure. We used the oleic acid infusion pig model of ARDS resembling human disease to explore cytokine changes in white blood cells (WBC) and plasma proteins, comparing baseline to ARDS values. Methods: Nineteen juvenile female swine were included in the study. ARDS defined by a PaO2/FiO2 ratio < 300 was induced by continuous oleic acid infusion. Arterial blood was drawn before and during oleic acid infusion, and when ARDS was established. Cytokine expression in WBC was analyzed by RT-qPCR and plasma protein expression by ELISA. Results: The median concentration of IFN-γ mRNA was estimated to be 59% (p = 0.006) and of IL-6 to be 44.4% (p = 0.003) of the baseline amount. No significant changes were detected for TNF-α, IL-17, and IL-10 mRNA expression. In contrast, the concentrations of plasma IFN-γ and IL-6 were significantly higher (p = 0.004 and p = 0.048 resp.), and TNF-α was significantly lower (p = 0.006) at ARDS compared to baseline. Conclusions: The change of proinflammatory cytokines IFN-γ and IL-6 expression is different comparing mRNA and plasma proteins at oleic acid-induced ARDS compared to baseline. The migration of cells to the lung may be the cause for this discrepancy.

Circulating Surfactant Protein D: A Biomarker for Acute Lung Injury?

Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are life-threatening lung diseases in critically ill patients. The lack of prognostic biomarkers has halted detection methods and effective therapy development. Quantitative biomarker-based approaches in the systemic circulation have been proposed as a means of enhancing diagnostic strategies as well as pharmacotherapy in a patient-specific manner. Pulmonary surfactants are complex mixtures made up of lipids and proteins, which are secreted into the alveolar space by epithelial type II cells under normal and pathological conditions. In this review, we summarize the current knowledge of SP-D in lung injury from both preclinical and clinical studies. Among surfactant proteins, surfactant protein-D (SP-D) has been more widely studied in ALI and ARDS. Recent studies have reported that SP-D has a superior discriminatory ability compared to other lung epithelial proteins for the diagnosis of ARDS, which could reflect the severity of lung injury. Furthermore, we shed light on recombinant SP-D treatment and its benefits as a potential drug for ALI, and we encourage further studies to translate SP-D into clinical use for diagnosis and treatment.

Inflammatory Biomarkers Are Associated With a Decline in Functional Status at Discharge in Children With Acute Respiratory Failure: An Exploratory Analysis

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To evaluate the link between early acute respiratory failure and functional morbidity in survivors using the plasma biomarkers interleukin-8, interleukin-1 receptor antagonist, thrombomodulin, and plasminogen activator inhibitor-1. We hypothesized that children with acute respiratory failure with higher levels of inflammation would have worse functional outcomes at discharge, as measured by Pediatric Overall Performance Category.

The application value of lung ultrasound findings in preterm infants with bronchopulmonary dysplasia

BACKGROUND

The purpose of this study was to investigate the association between ultrasound findings and preterm infants with bronchopulmonary dysplasia (BPD).

METHODS

Preterm infants with a gestation age of less than 28 weeks or birthweight less than 1,500 g admitted to the neonatal intensive care unit (NICU) in the Chengdu Women's & Children's Central Hospital from June 2018 to June 2019 were enrolled in the study and divided into 2 groups: the BPD group and the non-BPD group. All clinical data and lung ultrasound were retrospectively analyzed.

RESULTS

A total of 81 neonates (gestational age =29.71±2.27 weeks; birth weight =1,189.5±184.5 g) were enrolled in our center. The regression analysis showed that gestational age [odds ratio (OR) =0.57; 95% confidence interval (CI): 0.42-0.77, P=0.0002], birthweight (OR =0.99; 95% CI: 0.99-1.00, P<0.0001), mild asphyxia (OR =3.3; 95% CI: 1.24-8.74, P=0.0165), anemia (OR =4.43; 95% CI: 1.34-14.64, P=0.0146), blood transfusion (OR =3.68; 95% CI: 1.38-9.79, P=0.0090), respiratory failure (OR =6.58; 95% CI: 1.27-34.08, P=0.0486), heart failure (OR =6.58; 95% CI: 1.27-34.08, P=0.0248), and "debris" lung ultrasound findings (OR =21.82; 95% CI: 2.63-181.11, P=0.0043) were correlated with BPD.

CONCLUSIONS

BPD-related lung ultrasound findings can be a kind of imaging marker to diagnose BPD.