Alveolar compartmentalization of inflammatory and immune cell biomarkers in pneumonia-related ARDS
Open Access
- 9 January 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Critical Care
- Vol. 25 (1), 1-13
- https://doi.org/10.1186/s13054-020-03427-y
Abstract
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. 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. 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. 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.Keywords
Funding Information
- Société de Réanimation de Langue Française (2013 Clinical Research Grant)
This publication has 52 references indexed in Scilit:
- Monitoring the immune response in sepsis: a rational approach to administration of immunoadjuvant therapiesCurrent Opinion in Immunology, 2013
- Viral acute lower respiratory infections impair CD8+ T cells through PD-1JCI Insight, 2012
- Mechanisms of Indirect Acute Lung InjuryAnnals of Surgery, 2012
- Immunosuppression in Patients Who Die of Sepsis and Multiple Organ FailureJAMA, 2011
- A dynamic view of mHLA-DR expression in management of severe septic patientsCritical Care, 2011
- Programmed death-1 levels correlate with increased mortality, nosocomial infection and immune dysfunctions in septic shock patientsCritical Care, 2011
- Upregulation of programmed death-1 on T cells and programmed death ligand-1 on monocytes in septic shock patientsCritical Care, 2011
- The PD‐1 pathway in tolerance and autoimmunityImmunological Reviews, 2010
- Prognostic and Pathogenetic Value of Combining Clinical and Biochemical Indices in Patients With Acute Lung InjurySocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2010
- PD-1 expression by macrophages plays a pathologic role in altering microbial clearance and the innate inflammatory response to sepsisProceedings of the National Academy of Sciences of the United States of America, 2009