Journal Article

Alveolar compartmentalization of inflammatory and immune cell biomarkers in pneumonia-related ARDS

Surenaud, Mathieu, Maitre, Bernard, Plonquet, Anne, Beldi-Ferchiou, Asma, Schlemmer, Frédéric, Bendib, Inès, Carteaux, Guillaume, Godot, Veronique, Razazi, Keyvan, Mekontso Dessap, Armand, de Prost, Nicolas, Hüe, Sophie

2021

Overview

Background Biomarkers of disease severity might help individualizing the management of patients with the acute respiratory distress syndrome (ARDS). Whether the alveolar compartmentalization of biomarkers has a clinical significance in patients with pneumonia-related ARDS is unknown. This study aimed at assessing the interrelation of ARDS/sepsis biomarkers in the alveolar and blood compartments and explored their association with clinical outcomes. Methods Immunocompetent patients with pneumonia-related ARDS admitted between 2014 and 2018 were included in a prospective monocentric study. Bronchoalveolar lavage (BAL) fluid and blood samples were obtained within 48 h of admission. Twenty-two biomarkers were quantified in BAL fluid and serum. HLA-DR + monocytes and CD8 + PD-1 + lymphocytes were quantified using flow cytometry. The primary clinical endpoint of the study was hospital mortality. Patients undergoing a bronchoscopy as part of routine care were included as controls. Results Seventy ARDS patients were included. Hospital mortality was 21.4%. The BAL fluid-to-serum ratio of IL-8 was 20 times higher in ARDS patients than in controls ( p  < 0.0001). ARDS patients with shock had lower BAL fluid-to-serum ratio of IL-1Ra ( p  = 0.026), IL-6 ( p  = 0.002), IP-10/CXCL10 ( p  = 0.024) and IL-10 ( p  = 0.023) than others. The BAL fluid-to-serum ratio of IL-1Ra was more elevated in hospital survivors than decedents ( p  = 0.006), even after adjusting for SOFA and driving pressure ( p  = 0.036). There was no significant association between alveolar or alveolar/blood monocytic HLA-DR or CD8 + lymphocytes PD-1 expression and hospital mortality. Conclusions IL-8 was the most compartmentalized cytokine and lower BAL fluid-to-serum concentration ratios of IL-1Ra were associated with hospital mortality in patients with pneumonia-associated ARDS.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Acute respiratory distress syndrome / Adult / Bacterial pneumonia / Biological markers / Biomarkers / Blood cells / Bronchoscopy / Clinical outcomes / Complications and side effects / Critical care / Critical Care Medicine / Cytokines / Emergency Medicine / Health aspects / Histocompatibility antigens / HLA histocompatibility antigens / HLA-DR antigens / Intensive / Lavage / Life Sciences / Measurement / Medicine / Medicine & Public Health / Mortality / Nosocomial infections / Patient outcomes / Patients / PD-1 / Pneumonia / Prognosis / Respiratory distress syndrome / Sepsis / Software / Tumor necrosis factor-TNF / Variables / Ventilators