Role of Pentraxin-3 Compared to C-Reactive Protein in Predicting the Outcome of Acute Lung Injury and Acute Respiratory Distress Syndrome

Abstract

Acute lung injury (ALI) and its severe form, acute respiratory distress syndrome (ARDS), continue to be significant challenges to critical care physicians throughout the world. It is characterized by persistent refractory hypoxemia resulting in respiratory failure. ALI/ARDS activates several cellular and molecular cascades that result in circulating inflammatory and pro-thrombotic mediators as well as pathophysiologic disturbances that may be important determinants of mortality. ARDS typically develops within 12-48 hours after the inciting event, although in rare instances, it may occur within a few days. The current study was a cross-sectional observational study. It was carried out on 50 acutely intoxicated patients of both sexes, who were admitted to the ICU of Poison Control Center of Ain Shams University hospitals (PCCA), and intubated with suspected acute lung injury (according to lung injury score). It aimed at assessment of the severity of various toxin – related ALI/ARDS in patients admitted to the ICU of the PCCA, evaluating and comparing the role of pentraxin-3 (PTX3) and C-reactive protein (CRP) as early predictors of severity and outcome in ALI/ARDS and finally reviewing and analyzing data about ALI/ARDS collected from literature. Exclusion Criteria: Based on the possibility of alteration in lung parameters and/or in the levels of the measured biomarkers, the following patients were excluded: 1. Patients less than 18 years and more than 65 years. 2. Pregnant females. 3. Patients transferred from another ICU and/or intubated for a period longer than 24 hours. 4. Death within 24 hours of ALI diagnosis. 5. History of respiratory disease or pulmonectomy or pulmonary resection within 1 month before endotracheal intubation 6. History of cardiovascular disease or acute myocardial infarction. 7. History of renal disease. 8. History of hepatic disease. 9. History of active malignancy, intake of immunosuppressive drugs (e.g. corticosteroids), previous radiotherapy or chemotherapy. In each patient the following data were obtained: I- Sociodemographic data: Including data regarding age and sex. II- Medical evaluation: Including the patient’s medical data and the poisoning circumstances, including mode of poisoning, delay time of poisoning (time lapse between poisoning and arrival to the PCC), route of poisoning, co-ingestion of other drugs or agents, presence of co-morbidities and history of medications, pre-consultation management and finally agents responsible for intoxication. III- Investigational parameters: Including routine laboratory investigations in addition to estimation of plasma PTX3 and serum CRP levels on the 1st, 2nd, and 5th days of the study. IV- Treatment.