| Alveolar fibrocyte percentage is an independent predictor of poor outcome in patients with acute lung injury. | |
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MedLine Citation:
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PMID: 21926612 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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OBJECTIVE:: Fibrocytes are mesenchymal progenitors involved in normal and pathologic repair. The aims of this study were: 1) to quantify fibrocytes in bronchoalveolar lavage fluid from patients with or without acute lung injury and acute respiratory distress syndrome; and 2) to evaluate the prognostic value of bronchoalveolar lavage fibrocyte percentage in patients with acute lung injury and acute respiratory distress syndrome. DESIGN:: Prospective cohort study. SETTING:: Three intensive care units of a large tertiary referral center. PATIENTS:: One hundred twenty-two ventilated patients requiring bronchoalveolar lavage were enrolled (62 acute respiratory distress syndrome, 30 acute lung injury, 30-ventilated patients without acute lung injury and acute respiratory distress syndrome). INTERVENTIONS:: After bronchoalveolar lavage collection during standard care, the patients were followed up for 28 days and clinical outcome was recorded. Fibrocytes (CD45+/collagen 1+) were quantified in bronchoalveolar lavage by flow cytometry. Comparison of bronchoalveolar lavage fibrocyte percentage from patients with or without acute lung injury and acute respiratory distress syndrome was performed using a Wilcoxon test. A multivariate analysis using a Cox model was performed to study the independent predictors of survival. MEASUREMENTS AND MAIN RESULTS:: Fibrocytes were detected in 90 of 92 (98%) bronchoalveolar lavages from patients with acute lung injury and acute respiratory distress syndrome. The median percentage of bronchoalveolar lavage fibrocytes was significantly higher in patients with acute lung injury and acute respiratory distress syndrome (5.0%) in comparison with ventilated control subjects (0.9%, p < .0001). After adjustment for age, comorbidity of malignancy, and severity of illness, a bronchoalveolar lavage fibrocyte percentage >6% was independently associated with a higher 28-day mortality in patients with acute lung injury and acute respiratory distress syndrome (hazard ratio [95% confidence interval], 6.15 [2.78-13.64], p ≤ .0001). Addition of bronchoalveolar lavage fibrocyte percentage in a clinical model predicting mortality in patients with acute lung injury and acute respiratory distress syndrome improved global fit and discriminatory capacity (c-statistic, 0.78-0.85; p = .007). CONCLUSIONS:: Fibrocytes are detectable in bronchoalveolar lavage during acute lung injury and acute respiratory distress syndrome. A bronchoalveolar lavage fibrocyte percentage >6% provides an additive prognostic value to clinical predictors and may be useful to identify patients with acute lung injury and acute respiratory distress syndrome at highest risk of an adverse outcome. |
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Authors:
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Christophe Quesnel; Pascale Piednoir; Julien Gelly; Laurent Nardelli; Marc Garnier; Véronique Leçon; Sigismond Lasocki; Lila Bouadma; Ivan Philip; Carole Elbim; France Mentré; Paul Soler; Bruno Crestani; Monique Dehoux |
Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-9-15 |
Journal Detail:
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Title: Critical care medicine Volume: - ISSN: 1530-0293 ISO Abbreviation: - Publication Date: 2011 Sep |
Date Detail:
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Created Date: 2011-9-19 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0355501 Medline TA: Crit Care Med Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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From Inserm (CQ, PP, LN, MG, PS, BC, MD), unité 700, Université Paris 7 Denis Diderot, Paris, France; Assistance Publique-Hôpitaux de Paris (CQ, MG), Hôpital Tenon, Service d'Anesthésie et de Réanimation Chirurgicale, Paris, France; Assistance Publique-Hôpitaux de Paris (PP, SL, IP), Hôpital Bichat, Département d'Anesthésie-Réanimation, Paris, France; Assistance Publique-Hôpitaux de Paris (JG, FM), Hôpital Bichat, UF de Biostatistiques, Paris, France; Département de médecine générale de la Faculté de Médecine Paris 7 Denis-Diderot (JG), Paris, France; Assistance Publique-Hôpitaux de Paris (VL, MD), Hôpital Bichat, Laboratoire de Biochimie A, Paris, France; Assistance Publique-Hôpitaux de Paris (LB), Hôpital Bichat, Service de Réanimation médicale, Paris, France; Assistance Publique-Hôpitaux de Paris (CE), Hôpital Bichat, Service d'Immunologie et d'Hématologie, Paris, France; Inserm (FM), unité 738, Université Paris 7 Denis Diderot, Paris, France; and Assistance Publique-Hôpitaux de Paris (BC), Hôpital Bichat, Service de Pneumologie, Paris, France. |
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