Evaluation of von Willebrand factor as a Marker For early diagnosis of Acute Respiratory Distress Syndrome (A.R.D.S) in comparison to Interleukin 6

Abstract

Acute respiratory distress syndrome (ARDS) is a respiratory disorder characterized by fluid accumulation in thelung alveoli (non-cardiogenic pulmonary edema) that leads to severe respiratory failure making the patient more prone to mechanical ventilation. The diagnosis of ARDS depends mainly on immunological bases as many inflammatory mediators may be increasedat the early stages of ARDS; IL6is one of them and could be considered as early biomarker for ARDS progress. Systemic endothelial activation and injury are important features of ARDS, so plasma levels of von Willebrand factor (VWF), a marker of endothelial activation and injury, would be expected to be associated with early diagnosis and clinical progress of acute respiratory distress syndrome (ARDS). The primary objective of this study was to test the hypothesis that Von Willebrand factor is an important determinant of early detection of acute respiratory distress syndrome in comparison to interleukin 6 (an early predictor cytokine of A.R.D.S). After obtaining approval of the institutional ethics committee,sixty critically ill patients were randomly chosen to be enrolled in this study. Patients should have one or more risk factor for development of acute respiratory distress syndrome either in the form ofdirectlunginjurycausese.g.:(severe pneumonia (infection), aspiration pneumonitis, inhalation lung injury, severe trauma to the chest)orIndirectlung injurycausese.g. ( systemic sepsis , severe injury or trauma, incompatible blood transfusion TRALI (transfusion related acute lung injury), acute pancreatitis , fracture of the long bones ,near drowning ,anaphylaxis, uremia ,fat embolus ) On the start of the study demographics, age, sex, weight,APACHEIIscore and cause of admission recorded. Patients were monitored using ECG non-invasive, invasive blood pressure monitoring, and Spo2 using pulse oximetry. Also the whole study patients were subjected to the following: clinical parameter: complete general examination and recording of data of admission, laboratory parameter: CBC, renal function test, liver function tests, hematologic assessment, coagulation profile)and radiological parameter: chest Xray with calculation of Murry score of the lung injury, ECG and echocardiography for some patients according to the clinical condition, In addition to: measurements of respiratory parameter: respiratory rate- ABG -arterial oxygen parameters. Levels of both VWF and IL.6 measured on T=0 i.e. (at start of the study once the patient considered to be risky for A.R.D.S to obtain their baseline levels), T=48 (after two days), and T=72 (after three days), significant correlations between VWF& IL6concentrations during the study and the development of A.R.D.S were analyzed.