Plasma Angiopoietin-2 Predicts the Onset of Acute Lung Injury in Critically III Patients

School of Medicine, UCSF, San Francisco, California, United States.
American Journal of Respiratory and Critical Care Medicine (Impact Factor: 11.04). 01/2013; 187(7). DOI: 10.1164/rccm.201208-1460OC
Source: PubMed

ABSTRACT RATIONALE: Current clinical prediction scores for acute lung injury (ALI) have limited positive predictive value. No studies have evaluated predictive plasma biomarkers in a broad population of critically ill patients or as an adjunct to clinical prediction scores. OBJECTIVES: To determine whether plasma Angiopoietin-2 (Ang-2), von Willebrand factor (vWF), interleukin-8 (IL-8) and/or receptor for advanced glycation end-products (sRAGE) predict ALI in critically ill patients. METHODS: Plasma samples were drawn from critically ill patients (n=230) identified in the emergency department. Patients who had ALI at baseline or in the subsequent 6 hours were excluded, and the remaining patients were followed for development of ALI. MEASUREMENTS AND MAIN RESULTS: Nineteen patients developed ALI at least 6 hours after the sample draw. Higher levels of Ang-2 and IL-8 were significantly associated with increased development of ALI (p=0.0008, 0.004 respectively). The association between Ang-2 and subsequent development of ALI was robust to adjustment for sepsis and vasopressor use. Ang-2 and the Lung Injury Prediction Score each independently discriminated well between those who developed ALI and those who did not (AUROC 0.74 for each), and using the two together improved the AUC to 0.84 (vs 0.74, p=0.05). In contrast, plasma levels of sRAGE and vWF were not predictive of ALI. CONCLUSIONS: Plasma biomarkers such as Ang-2 can improve clinical prediction scores and identify patients at high risk for ALI. In addition, the early rise of Ang-2 emphasizes the importance of endothelial injury in the early pathogenesis of ALI.

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