Impact of Serum Biomarkers and Clinical Factors on Intensive Care Unit Mortality and 6-Month Outcome in Relatively Healthy Patients with Severe Pneumonia and Acute Respiratory Distress Syndrome

Abstract

Objectives. This study aimed to identify the independent biomarkers and clinical factors that could predict ICU mortality and 6-month outcomes in relatively healthy patients with severe pneumonia and acute respiratory distress syndrome (ARDS). Patients and Methods. We prospectively enrolled patients with severe pneumonia-related ARDS that required mechanical ventilation. Patients were excluded if they were unable to take care of themselves. Several biomarkers and clinical factors were evaluated prospectively on day 1 and day 3 after ICU admission. All biomarkers and clinical factors were collected for analysis. Results. 56 patients were enrolled in this study. We determined that the initial appropriate antibiotics use was an independent clinical factor and day 1 high-mobility group protein B1 (HMGB1) concentration was an independent biomarker for ICU mortality. Interestingly, we also found that a low day 1 albumin level was an independent biomarker for predicting patient life dependence 6 months after a pneumonia event. Conclusion. Patients with severe pneumonia and ARDS requiring mechanical ventilation experience high rates of ICU mortality or disability, even if they were quite healthy before. Initial appropriate antibiotics use and day 1 level of HMGB1 were independent factors for predicting ICU mortality. Day 1 albumin level was predictive of 6-month patient life dependence.

Kaempferol Improves Lung Ischemia-Reperfusion Injury via Antiinflammation and Antioxidative Stress Regulated by SIRT1/HMGB1/NF-κB Axis

“…HMGB1 is a highly conserved non-histone chromosome binding protein, which is closely related to a variety of lung diseases, including pneumonia (Tseng et al, 2014), tuberculosis (Zeng et al, 2015), chronic obstructive pulmonary disease (Sukkar et al, 2012), pulmonary fibrosis (Smit et al, 2014), and lung transplantation (Weber et al, 2014). Normally, HMGB1 is mainly concentrated in the nucleus.…”

Extracellular HMGB1: a therapeutic target in severe pulmonary inflammation including COVID-19?

“…Excessive extracellular HMGB1 quantities cause tissue damage and organ dysfunction. In a clinical study, lethality in bacterial pneumonia complicated by ARDS was strongly predicted by initial appropriate antibiotic use and plasma HMGB1 levels (Tseng et al 2014). Treatment with HMGB1-specific antagonists ameliorates inflammation and improves survival in many preclinical models of acute or chronic inflammatory diseases (Andersson and Tracey 2011;Kang et al 2014;Andersson et al 2018b;Yang et al 2020).…”

Recent insight into potential acute respiratory distress syndrome

“…However, it is not statistically significant in multivariate analysis. This may be due to the small sample size (n=56) 42. In contrast, on meta-analysis carried out by Terpstra et al,23 IL-8 was independently associated with the outcome of ARDS with OR 3.35 (1.96-5.71) 7.…”

“…The high serum level of IL-8 is associated with severe illness and mortality 41. Tseng et al42 found that higher levels of IL-8 was observed in ICU non-survivors. However, it is not statistically significant in multivariate analysis.…”