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Comparative analysis of compartment-specific immunothrombotic biomarker profiles in bronchoalveolar lavage fluid and serum of patients with pneumonia-related acute respiratory distress syndrome: A preliminary cross-sectional study

急性呼吸窘迫综合征 医学 支气管肺泡灌洗 肺炎 生物标志物 呼吸机相关性肺炎 内科学 弥漫性血管内凝血 胃肠病学 全身炎症 沙发评分 免疫学 病理 重症监护室 炎症 生物化学 化学
作者
Xiaolong Zong,Xuechao Wang,Yaru Liu,Xiao Wang,Duanyang Li,Zhiqing Zhou,Zhenyu Li
出处
期刊:Journal of Investigative Medicine [BMJ]
标识
DOI:10.1177/10815589241288515
摘要

Immunothrombosis has emerged as a potential mechanistic link underlying the development and progression of acute respiratory distress syndrome (ARDS), but understanding its specific profile in patients, both locally and systemically, is limited. The objective of this study was to characterize and compare the immunothrombotic signatures in patients diagnosed with pneumonia-related ARDS (p-ARDS) at both the pulmonary and systemic levels and to evaluate their clinical relevance. The study included 23 consecutive patients diagnosed with p-ARDS admitted to the intensive care unit at a tertiary university hospital from July 2022 to May 2023, alongside 40 concurrently hospitalized patients with common pneumonia as controls. Paired bronchoalveolar lavage fluid (BALF) and serum samples were collected from the participants for the analysis of 15 biomarkers to assess and quantify the pulmonary and systemic immunothrombotic signatures. The study results revealed significant pulmonary inflammation and systemic endothelial injury in p-ARDS patients compared to pneumonia controls. These observations were maintained after adjustment for severity of illness (Acute Physiology and Chronic Health Evaluation [APACHE] II scores). In terms of clinical relevance, inflammatory biomarkers (interleukin [IL]-6, IL-8) in BALF were found to correlate with PaO2/FiO2 ratio, while serum levels of ADAMTS-13 and thrombomodulin (TM) showed associations with Sequential Organ Failure Assessment (SOFA) and Disseminated Intravascular Coagulation (DIC) scores. In conclusion, this preliminary investigation identified compartment-specific variations in the immunothrombotic signature between patients with p-ARDS and those with pneumonia alone, with inflammatory responses predominantly localized in the alveolar compartments and coagulation/endothelial injury biomarkers more pronounced in peripheral blood.
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