The clinical significance of serum and bronchoalveolar lavage inflammatory cytokines in patients at risk for Acute Respiratory Distress Syndrome

Abstract

BackgroundThe predictive role of many cytokines has not been well defined in Acute Respiratory Distress Syndrome (ARDS).MethodsWe measured prospectively IL-4, IL-6, IL-6 receptor, IL-8, and IL-10, in the serum and bronchoalveolar lavage fluid (BALF) in 59 patients who were admitted to ICU in order to identify predictive factors for the course and outcome of ARDS. The patients were divided into three groups: those fulfilling the criteria for ARDS (n = 20, group A), those at risk for ARDS and developed ARDS within 48 hours (n = 12, group B), and those at risk for ARDS but never developed ARDS (n = 27, group C).ResultsAn excellent negative predictive value for ARDS development was found for IL-6 in BALF and serum (100% and 95%, respectively). IL-8 in BALF and IL-8 and IL-10 serum levels were higher in non-survivors in all studied groups, and were associated with a high negative predictive value. A significant correlation was found between IL-8 and APACHE score (r = 0.60, p < 0.0001). Similarly, IL-6 and IL-6r were highly correlated with PaO2/FiO2 (r = -0.27, p < 0.05 and r = -0.55, p < 0.0001, respectively).ConclusionsBALF and serum levels of the studied cytokines on admission may provide valuable information for ARDS development in patients at risk, and outcome in patients either in ARDS or in at risk for ARDS.

Enhanced resolution of experimental ARDS through IL-4-mediated lung macrophage reprogramming

“…Furthermore, blocking endogenous IL-4 impaired ALI resolution and reduced expression of M2 macrophage proteins and therefore offers strong support as to the importance of IL-4 in endogenous ALI resolution. As such, our enthusiasm for the therapeutic potential of IL-4 is not diminished by prior reports that demonstrate a lack of consistent association between serum or BAL IL-4 levels with better outcome in human ARDS (6,37). Because our focus was to understand whether exogenous IL-4 could accelerate resolution and lung repair in a macrophagedependent manner, we did not attempt to identify cellular sources of IL-4, although this will be important to investigate in future work.…”

Thoracotomy procedures effect cytokine levels after thoracoabdominal esophagectomy

“…There are few studies addressing cytokine levels after esophageal resection itself. To date, most studies deal with the comparison of cytokine levels between at-risk patients for lung injury and such which had developed ALI or even ARDS in the course of their disease in order to find cytokines which predict the development of lung injury and outcome (5,45,46).…”

Growth-Arrest-Specific 6 (GAS6) Protein in ARDS Patients: Determination of Plasma Levels and Influence of PEEP Setting

“…We found elevated IL-8 at day 0, in accordance with previous series of ARDS subjects. [13][14][15]17,20,21 Given the implication of IL-8 as an important pro-inflammatory mediator associated with the development of ARDS and with poor outcomes (worse mortality and fewer ventilator-free days), the observed correlation with GAS6 suggests that GAS6 is an important contributor to inflammation in ARDS.…”

“…3 We also found elevated IL-8 and VEGF at the onset of ARDS, confirming previous series. [13][14][15]17,[19][20][21] A positive correlation was found between GAS6 and IL-8. A significant decrease in GAS6 and IL-8 was observed in the high-PEEP group, but not in the low-PEEP group.…”

“…Additionally, we measured plasma interleukin-8 (IL-8) and vascular endothelial growth factor (VEGF) as established endothelial and leukocyte markers with important implications in ARDS. [13][14][15][16][17][18][19][20][21][22] …”