Plasma Receptor for Advanced Glycation Endproducts Predicts Duration of ICU Stay and Mechanical Ventilation in Patients Following Lung Transplantation
| Autor: | Tokujiro Uchida, Carolyn S. Calfee, Sandra Brady, M DeCamp, Alejandro C. Arroliga, Michael A. Matthay, Abigail R. Lara, Gwynne D. Church, Akitoshi Ishizaka, Justin L. Ranes, Marie Budev |
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| Jazyk: | angličtina |
| Rok vydání: | 2007 |
| Předmět: |
Pulmonary and Respiratory Medicine
Artificial ventilation Adult Male medicine.medical_specialty medicine.medical_treatment Receptor for Advanced Glycation End Products Primary Graft Dysfunction Article Cohort Studies Predictive Value of Tests Internal medicine medicine Lung transplantation Humans Prospective Studies Receptors Immunologic Mechanical ventilation Transplantation Lung business.industry Pneumonia Length of Stay Middle Aged Pulmonary edema medicine.disease Fluid transport Prognosis Respiration Artificial Surgery Intensive Care Units medicine.anatomical_structure Treatment Outcome Cardiology Linear Models Female Cardiology and Cardiovascular Medicine business Biomarkers Lung Transplantation |
| Popis: | Background Primary graft dysfunction, formerly termed reperfusion pulmonary edema, is the leading cause of short-term complications after lung transplantation. New evidence shows that alveolar type I epithelial cells play an active role in alveolar fluid transport and are therefore presumed to be critical in the absorption of pulmonary edema. We tested the potential relevance of a novel marker of alveolar type I cell injury, the receptor for advanced glycation end-products (RAGE), to short-term outcomes of lung transplantation. Methods The study was a prospective, observational cohort study of 20 patients undergoing single lung, bilateral lung or combined heart–lung transplantation. Plasma biomarkers were measured 4 hours after allograft reperfusion. Results Higher plasma RAGE levels were associated with a longer duration of mechanical ventilation and longer intensive care unit length of stay, in contrast to markers of alveolar type II cell injury, endothelial injury and acute inflammation. Specifically, for every doubling in plasma RAGE levels, the duration of mechanical ventilation increased on average by 26 hours, adjusting for ischemia time (95% confidence interval [CI] 7.4 to 44.7 hours, p = 0.01). Likewise, for every doubling of plasma RAGE levels, intensive care unit length of stay increased on average by 1.8 days, again adjusting for ischemia time (95% CI 0.13 to 3.45 days p = 0.04). In contrast, the clinical diagnosis of primary graft dysfunction was not as predictive of these short-term outcomes. Conclusions Higher levels of plasma RAGE measured shortly after reperfusion predicted poor short-term outcomes from lung transplantation. Elevated plasma RAGE levels may have both pathogenetic and prognostic value in patients after lung transplantation. |
| Databáze: | OpenAIRE |
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