Cargando…
Derivation and validation of a two-biomarker panel for diagnosis of ARDS in patients with severe traumatic injuries
BACKGROUND: Acute respiratory distress syndrome (ARDS) is common after severe traumatic injuries but is underdiagnosed and undertreated. We hypothesized that a panel of plasma biomarkers could be used to diagnose ARDS in severe trauma. To test this hypothesis, we derived and validated a biomarker pa...
Autores principales: | , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2017
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5887582/ https://www.ncbi.nlm.nih.gov/pubmed/29766112 http://dx.doi.org/10.1136/tsaco-2017-000121 |
_version_ | 1783312336690348032 |
---|---|
author | Ware, Lorraine B Zhao, Zhiguo Koyama, Tatsuki Brown, Ryan M Semler, Matthew W Janz, David R May, Addison K Fremont, Richard D Matthay, Michael A Cohen, Mitchell J Calfee, Carolyn S |
author_facet | Ware, Lorraine B Zhao, Zhiguo Koyama, Tatsuki Brown, Ryan M Semler, Matthew W Janz, David R May, Addison K Fremont, Richard D Matthay, Michael A Cohen, Mitchell J Calfee, Carolyn S |
author_sort | Ware, Lorraine B |
collection | PubMed |
description | BACKGROUND: Acute respiratory distress syndrome (ARDS) is common after severe traumatic injuries but is underdiagnosed and undertreated. We hypothesized that a panel of plasma biomarkers could be used to diagnose ARDS in severe trauma. To test this hypothesis, we derived and validated a biomarker panel in three independent cohorts and compared the diagnostic performance to clinician recognition of ARDS. METHODS: Eleven plasma biomarkers of inflammation, lung epithelial and endothelial injury were measured in a derivation cohort of 439 severe trauma patients. ARDS status was analyzed by two-investigator consensus, and cases were required to meet Berlin criteria on intensive care unit (ICU) day 1. Controls were subjects without ARDS during the first 4 days of study enrollment. A multivariable logistic regression model was used to generate probabilities for ARDS. A reduced model with the top two performing markers was then tested in two independent validation cohorts. To assess clinical diagnosis of ARDS, medical records in the derivation cohort were systematically searched for documentation of ARDS diagnosis made by a clinical provider. RESULTS: Among 11 biomarkers, the combination of the endothelial injury marker angiopoietin-2 (Ang-2) and the lung epithelial injury marker receptor for advanced glycation endproducts (RAGE) provided good discrimination for ARDS in the derivation cohort (area under the curve (AUC)=0.74 (95% CI 0.67 to 0.80). In the validation cohorts, the AUCs for this model were 0.70 (0.61 to 0.77) and 0.78 (0.71 to 0.84). In contrast, provider assessment demonstrated poor diagnostic accuracy for ARDS, with AUC of 0.55 (0.51 to 0.60). DISCUSSION: A two-biomarker panel consisting of Ang-2 and RAGE performed well across multiple patient cohorts and outperformed clinical providers for diagnosing ARDS in severe trauma. Clinical application of this model could improve both diagnosis and treatment of ARDS in patients with severe trauma. LEVEL OF EVIDENCE: Diagnostic study, level II. |
format | Online Article Text |
id | pubmed-5887582 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-58875822018-05-14 Derivation and validation of a two-biomarker panel for diagnosis of ARDS in patients with severe traumatic injuries Ware, Lorraine B Zhao, Zhiguo Koyama, Tatsuki Brown, Ryan M Semler, Matthew W Janz, David R May, Addison K Fremont, Richard D Matthay, Michael A Cohen, Mitchell J Calfee, Carolyn S Trauma Surg Acute Care Open Original Article BACKGROUND: Acute respiratory distress syndrome (ARDS) is common after severe traumatic injuries but is underdiagnosed and undertreated. We hypothesized that a panel of plasma biomarkers could be used to diagnose ARDS in severe trauma. To test this hypothesis, we derived and validated a biomarker panel in three independent cohorts and compared the diagnostic performance to clinician recognition of ARDS. METHODS: Eleven plasma biomarkers of inflammation, lung epithelial and endothelial injury were measured in a derivation cohort of 439 severe trauma patients. ARDS status was analyzed by two-investigator consensus, and cases were required to meet Berlin criteria on intensive care unit (ICU) day 1. Controls were subjects without ARDS during the first 4 days of study enrollment. A multivariable logistic regression model was used to generate probabilities for ARDS. A reduced model with the top two performing markers was then tested in two independent validation cohorts. To assess clinical diagnosis of ARDS, medical records in the derivation cohort were systematically searched for documentation of ARDS diagnosis made by a clinical provider. RESULTS: Among 11 biomarkers, the combination of the endothelial injury marker angiopoietin-2 (Ang-2) and the lung epithelial injury marker receptor for advanced glycation endproducts (RAGE) provided good discrimination for ARDS in the derivation cohort (area under the curve (AUC)=0.74 (95% CI 0.67 to 0.80). In the validation cohorts, the AUCs for this model were 0.70 (0.61 to 0.77) and 0.78 (0.71 to 0.84). In contrast, provider assessment demonstrated poor diagnostic accuracy for ARDS, with AUC of 0.55 (0.51 to 0.60). DISCUSSION: A two-biomarker panel consisting of Ang-2 and RAGE performed well across multiple patient cohorts and outperformed clinical providers for diagnosing ARDS in severe trauma. Clinical application of this model could improve both diagnosis and treatment of ARDS in patients with severe trauma. LEVEL OF EVIDENCE: Diagnostic study, level II. BMJ Publishing Group 2017-08-28 /pmc/articles/PMC5887582/ /pubmed/29766112 http://dx.doi.org/10.1136/tsaco-2017-000121 Text en © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/ |
spellingShingle | Original Article Ware, Lorraine B Zhao, Zhiguo Koyama, Tatsuki Brown, Ryan M Semler, Matthew W Janz, David R May, Addison K Fremont, Richard D Matthay, Michael A Cohen, Mitchell J Calfee, Carolyn S Derivation and validation of a two-biomarker panel for diagnosis of ARDS in patients with severe traumatic injuries |
title | Derivation and validation of a two-biomarker panel for diagnosis of ARDS in patients with severe traumatic injuries |
title_full | Derivation and validation of a two-biomarker panel for diagnosis of ARDS in patients with severe traumatic injuries |
title_fullStr | Derivation and validation of a two-biomarker panel for diagnosis of ARDS in patients with severe traumatic injuries |
title_full_unstemmed | Derivation and validation of a two-biomarker panel for diagnosis of ARDS in patients with severe traumatic injuries |
title_short | Derivation and validation of a two-biomarker panel for diagnosis of ARDS in patients with severe traumatic injuries |
title_sort | derivation and validation of a two-biomarker panel for diagnosis of ards in patients with severe traumatic injuries |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5887582/ https://www.ncbi.nlm.nih.gov/pubmed/29766112 http://dx.doi.org/10.1136/tsaco-2017-000121 |
work_keys_str_mv | AT warelorraineb derivationandvalidationofatwobiomarkerpanelfordiagnosisofardsinpatientswithseveretraumaticinjuries AT zhaozhiguo derivationandvalidationofatwobiomarkerpanelfordiagnosisofardsinpatientswithseveretraumaticinjuries AT koyamatatsuki derivationandvalidationofatwobiomarkerpanelfordiagnosisofardsinpatientswithseveretraumaticinjuries AT brownryanm derivationandvalidationofatwobiomarkerpanelfordiagnosisofardsinpatientswithseveretraumaticinjuries AT semlermattheww derivationandvalidationofatwobiomarkerpanelfordiagnosisofardsinpatientswithseveretraumaticinjuries AT janzdavidr derivationandvalidationofatwobiomarkerpanelfordiagnosisofardsinpatientswithseveretraumaticinjuries AT mayaddisonk derivationandvalidationofatwobiomarkerpanelfordiagnosisofardsinpatientswithseveretraumaticinjuries AT fremontrichardd derivationandvalidationofatwobiomarkerpanelfordiagnosisofardsinpatientswithseveretraumaticinjuries AT matthaymichaela derivationandvalidationofatwobiomarkerpanelfordiagnosisofardsinpatientswithseveretraumaticinjuries AT cohenmitchellj derivationandvalidationofatwobiomarkerpanelfordiagnosisofardsinpatientswithseveretraumaticinjuries AT calfeecarolyns derivationandvalidationofatwobiomarkerpanelfordiagnosisofardsinpatientswithseveretraumaticinjuries |