29-TNF Receptor Soluble Factor 1A but Not Other Biomarkers Correlates With Changing PARDS Severity
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Pediatrics, Pulmonary, 2021
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The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

James Williams

Introduction/Hypothesis: Pediatric acute respiratory distress syndrome (PARDS) is a significant cause of morbidity and mortality in the pediatric intensive care unit (PICU). To date, there have only been a few positive clinical trials in ARDS and PARDS. In ARDS, inflammatory serum biomarker profiles have identified sub-phenotypes that respond differently to interventions such as fluid administration and PEEP. In PARDS, biomarkers have been shown to correlate with PARDS severity, and no PARDS subgroups have been identified. We reasoned that PARDS biomarkers should correlate with PARDS severity and change with PARDS improvement or worsening.

Methods: This single center prospective observational study was conducted in a large PICU at a quaternary children's hospital. Control patients were defined as patients admitted to the PICU with no apparent respiratory disease. PARDS patients were under 18 years of age, mechanically ventilated, and met the consensus PARDS definition. Serum samples were collected on study days 1, 4, 7, and 14 and analyzed using Luminex. Statistical analyses were performed using the R statistical package.

Results: A total of 82 specimens from 11 control patients and 24 PARDS patients were analyzed. Levels of Granzyme B, ICAM-1, IFN-γ, IL-18, SPD, and TNF-α were all found to be significantly (Wilcoxon Rank Sum, p < 0.05) elevated in the serum of PARDS patients compared with control. However, there was no significant difference in the levels of these biomarkers comparing mild, moderate, and severe PARDS. In comparing change in biomarker level with changing PARDS severity, only TNF-α and TNFRSF1A were both positively and significantly correlated with increasing lung injury severity (Pearson correlation, R 0.31, p = 0.048 and R 0.54, p = 2.3 x 10-4 respectively).

Conclusions: In conclusion, several serum proteins are elevated in PARDS patients when compared to controls, but none were significantly greater with higher PARDS severity. Only changes in TNF-α and TNFRSF1A levels correlated with changing PARDS severity. While serum TNF-α and TNFRSF1A levels correlate with disease status in a given patient, the failure of any biomarker to correlate with PARDS severity suggests that distinct sub-classes of PARDS exist which need to be identified.

Meta Tag
Content Type Presentation
Knowledge Area Pediatrics
Knowledge Area Pulmonary
Knowledge Level Advanced
Membership Level Select
Tag Acute Respiratory Distress Syndrome ARDS
Year 2021
Pediatric Acute Respiratory Distress Syndrome
serum biomarkers
heart severity


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