Increased Extravascular Lung Water and Plasma Biomarkers of Acute Lung Injury Precede Oxygenation Impairment in Primary Graft Dysfunction After Lung Transplantation
| Autor: | Béatrice Uring-Lambert, Philippe Lassalle, Annick Steib, Pierre Diemunsch, Jean-Paul Schmitt, Bernard Geny, Olivier Helms, Nicolas Meyer, François Levy, Pierre-Emmanuel Falcoz, Anne-Claude Roche, Julien Pottecher, Tristan Dégot, J. G. Hentz, Romain Kessler, Gilbert Massard, Nicola Santelmo, Siamak Bahram, Mickaël Schaeffer, Olivier Collange |
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| Rok vydání: | 2017 |
| Předmět: |
Heart transplantation
Transplantation medicine.medical_specialty Lung business.industry medicine.medical_treatment Primary Graft Dysfunction respiratory system 030204 cardiovascular system & hematology Lung injury Pulmonary edema medicine.disease 03 medical and health sciences 0302 clinical medicine medicine.anatomical_structure 030228 respiratory system Anesthesia Internal medicine Predictive value of tests medicine.artery Pulmonary artery medicine Cardiology Lung transplantation business |
| Zdroj: | Transplantation. 101:112-121 |
| ISSN: | 0041-1337 |
| DOI: | 10.1097/tp.0000000000001434 |
| Popis: | Background After lung transplantation (LT), early prediction of grade 3 pulmonary graft dysfunction (PGD) remains a research gap for clinicians. We hypothesized that it could be improved using extravascular lung water (EVLWi) and plasma biomarkers of acute lung injury. Methods After institutional review board approval and informed consent, consecutive LT recipients were included. Transpulmonary thermodilution-based EVLWi, plasma concentrations of epithelial (soluble receptor for advanced glycation endproducts [sRAGE]) and endothelial biomarkers (soluble intercellular adhesion molecule-1 and endocan [full-length and cleaved p14 fragment]) were obtained before and after LT (0 [H0], 6, 12, 24, 48 and 72 hours after pulmonary artery unclamping). Grade 3 PGD was defined according to the International Society for Lung and Heart Transplantation definition, combining arterial oxygen partial pressure (PaO2)/inspired fraction of oxygen (FiO2) ratio and chest X-rays. Association of clinical risk factors, EVLWi and biomarkers with grade 3 PGD was analyzed under the Bayesian paradigm, using logistic model and areas under the receiver operating characteristic curves (AUCs). Results In 47 LT recipients, 10 developed grade 3 PGD, which was obvious at H6 in 8 cases. Clinical risk factors, soluble intercellular adhesion molecule-1 and endocan (both forms) were not associated with grade 3 PGD. Significant predictors of grade 3 PGD included (1) EVLWi (optimal cutoff, 13.7 mL/kg; AUC, 0.74; 95% confidence interval [CI], 0.48-0.99), (2) PaO2/FiO2 ratio (optimal cutoff, 236; AUC, 0.68; 95% CI, 0.52-0.84), and (3) sRAGE (optimal cutoff, 11 760 pg/mL; AUC, 0.66; 95% CI, 0.41-0.91) measured at H0. Conclusions Immediate postreperfusion increases in EVLWi and sRAGE along with impaired PaO2/FiO2 ratios were early predictors of grade 3 PGD at or beyond 6 hours and may trigger early therapeutic interventions. |
| Databáze: | OpenAIRE |
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