Daily Ards Research Analysis

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is characterised by progressive loss of pulmonary function and poor survival. Although biomarkers for disease progression and mortality exist, their reliability in large studies remains unproven. This study investigates prognostic biomarkers from the ISABELA trials, the largest IPF cohort to date, to identify those predicting worse clinical outcomes. METHODS: Plasma from 1280 IPF patients in ISABELA 1 and 2 (NCT03711162, NCT03733444) was analysed for 17 circulating soluble disease-related biomarkers at multiple time-points and for the RESULTS: Patients with ≥10% annual decline in FVC had higher median baseline of matrix metalloproteinase-7 (MMP-7) CONCLUSIONS: We provide new insights into the prognostic value of MMP-7 and CCL18 in identifying high-risk IPF patients in the largest cohort to date. The combination of high baseline MMP-7 and CCL18 levels, along with longitudinal changes in CCL18, has the potential to enhance risk stratification and support efficacy assessment and monitoring in clinical trials.

PURPOSE OF RESEARCH: Acute respiratory distress syndrome (ARDS) carries high mortality, and conventional physiological indices incompletely reflect disease trajectory and outcomes. Endogenous carboxyhemoglobin (COHgb), a marker of heme oxygenase-1 activity and oxidative stress, may offer additional prognostic value. This study evaluated whether arterial COHgb levels, measured at defined stages of ARDS, are associated with mortality, intensive care unit (ICU) free days, and ventilator-free days, and whether these associations differ between COVID-19 and non-COVID-19 ARDS. METHODS: In this retrospective cohort study (2017-2021), non-smoking adults meeting Berlin criteria for ARDS across two ICUs were included. COHgb and physiological parameters were recorded at the predefined time periods of ARDS. The primary outcome was in-hospital mortality; secondary outcomes included ICU-free and ventilator-free days. Multivariable logistic regression and receiver operating characteristic analyses compared the predictive performance of COHgb with APACHE II, SOFA, SAPS II scores, and PaO RESULTS: Ninety-five patients were analyzed (42 survivors, 53 non-survivors). Day 3 COHgb was higher in non-survivors than survivors (median 1.47 vs. 0.97; P = 0.002). In multivariable analysis, only Day 3 COHgb independently predicted mortality (adjusted OR 3.15; 95% CI 1.19-8.32; P = 0.020) with an AUC of 0.70 (sensitivity 69%, specificity 64%). Findings were consistent across COVID-19 and non-COVID-19 subgroups. CONCLUSION: Arterial COHgb may serve as a prognostic marker of mortality in ARDS, after adjustment for established severity scores and oxygenation indices. Given the modest sample size, these results should be viewed as hypothesis generating and require confirmation in larger, multicenter cohorts.

INTRODUCTION: The combined use of venovenous extracorporeal membrane oxygenation (VV-ECMO) and damage-control laparotomy/open abdomen (DCL/OA) is not well described in the literature. We hypothesized that the mortality with concurrent VV-ECMO and DCL/OA would not be statistically different from that reported for either intervention alone. METHODS: Patients managed with a DCL/OA and VV-ECMO from March 2014 through March 2022 were retrospectively reviewed from a prospectively collected database at a single quaternary care center. The primary outcome was in-hospital mortality. Survivor and nonsurvivor cohorts were compared using univariate and bivariate analyses with a priori significance at p ≤ 0.05. A multivariable regression analyses was performed to identify independent predictors of mortality. RESULTS: Fifty-two patients were managed with VV-ECMO and concurrent DCL/OA. The majority of patients were male (58%), with a mean (SD) age of 41 (14) years. The primary indication for VV-ECMO was acute respiratory distress syndrome/pneumonia (83%). The primary indications for DCL/OA were abdominal compartment syndrome (37%) and trauma (19%). Sixty percent of the patients underwent VV-ECMO cannulation after DCL/OA. Survival at hospital discharge was 58%. Survivors had a lower mean Sequential Organ Failure Assessment score (12 vs. 14, p = 0.02), higher mean Respiratory ECMO Survival Prediction score (3.5 vs. 1.1, p = 0.004), lower mean preoperative lactic acid level (4 vs. 7, p = 0.04) and were more likely to receive anticoagulation while on VV-ECMO (70% vs. 30%, p = 0.012) than nonsurvivors. Postdischarge, survival rates at 3, 6, 9, and 12 months were 90%, 72%, 69%, and 62%, respectively. After adjusting for confounders, the use of anticoagulation (odds ratio, 0.08; 95% confidence interval, 0.01-0.42) and a higher Respiratory ECMO Survival Prediction score (odds ratio, 0.71; 95% confidence interval, 0.53-0.95) were associated with decreased mortality. CONCLUSION: Relatively favorable outcomes are often achieved in acute care surgery patients treated with concomitant VV-ECMO and DCL/OA. Venovenous extracorporeal membrane oxygenation should not be considered a contraindication to DCL/OA and vice versa. LEVEL OF EVIDENCE: Retrospective Cohort Study; Level III.