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Critical Care
Published in: Critical Care 1/2017

Open Access 01-12-2017 | Research

Circulating microparticle levels are reduced in patients with ARDS

Authors: Ciara M. Shaver, Justin Woods, Jennifer K. Clune, Brandon S. Grove, Nancy E. Wickersham, J. Brennan McNeil, Gregory Shemancik, Lorraine B. Ware, Julie A. Bastarache

Published in: Critical Care | Issue 1/2017

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Abstract

Background

It is unclear how to identify which patients at risk for acute respiratory distress syndrome (ARDS) will develop this condition during critical illness. Elevated microparticle (MP) concentrations in the airspace during ARDS are associated with activation of coagulation and in vitro studies have demonstrated that MPs contribute to acute lung injury, but the significance of MPs in the circulation during ARDS has not been well studied. The goal of the present study was to test the hypothesis that elevated levels of circulating MPs could prospectively identify critically ill patients who will develop ARDS and that elevated circulating MPs are associated with poor clinical outcomes.

Methods

A total of 280 patients with platelet-poor plasma samples from the prospective Validating Acute Lung Injury biomarkers for Diagnosis (VALID) cohort study were selected for this analysis. Demographics and clinical data were obtained by chart review. MP concentrations in plasma were measured at study enrollment on intensive care unit (ICU) day 2 and on ICU day 4 by MP capture assay. Activation of coagulation was measured by plasma recalcification (clot) times.

Results

ARDS developed in 90 of 280 patients (32%) in the study. Elevated plasma MP concentrations were associated with reduced risk of developing ARDS (odds ratio (OR) 0.70 per 10 μM increase in MP concentration, 95% CI 0.50–0.98, p = 0.042), but had no significant effect on hospital mortality. MP concentration was greatest in patients with sepsis, pneumonia, or aspiration as compared with those with trauma or receiving multiple blood transfusions. MP levels did not significantly change over time. The inverse association of MP levels with ARDS development was most striking in patients with sepsis. After controlling for age, presence of sepsis, and severity of illness, higher MP concentrations were independently associated with a reduced risk of developing ARDS (OR 0.69, 95% CI 0.49–0.98, p = 0.038). MP concentration was associated with reduced plasma recalcification time.

Conclusions

Elevated levels of circulating MPs are independently associated with a reduced risk of ARDS in critically ill patients. Whether this is due to MP effects on systemic coagulation warrants further investigation.
Appendix
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Metadata
Title
Circulating microparticle levels are reduced in patients with ARDS
Authors
Ciara M. Shaver
Justin Woods
Jennifer K. Clune
Brandon S. Grove
Nancy E. Wickersham
J. Brennan McNeil
Gregory Shemancik
Lorraine B. Ware
Julie A. Bastarache
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2017
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-017-1700-7

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