RT Journal Article
SR Electronic
T1 Derivation and validation of a two-biomarker panel for diagnosis of ARDS in patients with severe traumatic injuries
JF Trauma Surgery & Acute Care Open
FD BMJ Publishing Group Ltd
SP e000121
DO 10.1136/tsaco-2017-000121
VO 2
IS 1
A1 Lorraine B Ware
A1 Zhiguo Zhao
A1 Tatsuki Koyama
A1 Ryan M Brown
A1 Matthew W Semler
A1 David R Janz
A1 Addison K May
A1 Richard D Fremont
A1 Michael A Matthay
A1 Mitchell J Cohen
A1 Carolyn S Calfee
YR 2017
UL http://tsaco.bmj.com/content/2/1/e000121.abstract
AB 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.