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Table 7 Studies measuring lung-specific proteins in patients with or at risk for ARDS

From: Serum biomarkers in Acute Respiratory Distress Syndrome an ailing prognosticator

Investigator Patients Controls Biomarker / Summary ROC curve analysis Cut-off values Specificity – Sensitivity Diagnostic accuracy Limitations
Doyle et al. 81 15 ARDSa
10 at risk
10 controls
SP-A is an acute indicator of lung function and alveolocapillary membrane injury No Not estimated Small number of patients
No ROC curve analysis / cut-off values
No definitive relation with disease severity
Doyle et al. 82 22 ARDSa
10 at risk
33 controls
Superiority of SP-B compared to SP-A plasma levels as a marker of lung function and alveolocapillary membrane injury No Not estimated Only 3 case-control studies
Inadequate sample size
Lack of adjustment with disease behaviour
No ROC curve analysis / cut-off values
Greene et al. 83 41 ARDSa
22 at risk
35 controls
SP-A, SP-B, SP-D
Serum changes found to be neither sensitive nor specific in predicting the onset of ARDS and discriminating survivors from non-survivors.
Yes
Not reported
Poor predictive value
Low specificity/sensitivity
Limited number of patients
Serial measurements for a short period of time/ Lack of serial measurement for the most severe forms
Heterogeneity of studied population
Poor predictive value for serum levels
Cheng et al. 84 36 ARDSa
2 ALI
SP-A levels were associated with severity of clinical lung injury and with disease outcome No Not estimated Small sample size
Causal diversity of studied population
No serial measurement
Greene et al. 85 51 at risk
26 ARDSa
16 controls
SP-A levels are predictive for at risk patients who developed ARDS from sepsis and aspiration but not trauma No Not estimated Small sample size
No ROC curve analysis / cut-off levels
Bersten et al. 86 54 at risk
9 controls
SP-B but not SP-A cut-off plasma levels predict ARDS development, particularly in at-risk patients suffering a direct lung injury Yes
SP-B: 4.994 ng/ml
78-85-85-78% Small number of patients
Limited follow-up serum data
Most of patients had already lung injury
Exclusion of milder at risk patients
Eisner et al. 87 565
ALI/ ARDSa
SP-A, SP-D
Attenuation of SP-D plasma levels by lower volume ventilation strategies
No Not estimated Only 2 serial measurements
Heterogeneity of studied population Potential selection bias
No ROC curve analysis / cut-off levels
Ishizaka et al. 95 35 at risk
27 ARDSa
21 controls
Association of optimal cut-off values of KL-6 serum levels with patients' mortality Yes
KL-6: 253 U/ml
100-87% Inadequate sample volume
Heterogeneity of studied population
Sato et al. 96 28 ARDSa
10 controls
Association of KL-6 serum levels with variables of lung injury severity and with mortality rates
No correlation with ventilation strategies
No Not estimated Small sample size
Heterogeneity of studied group
No serial measurement
No ROC curve analysis / cut-off levels
Diversity of ventilatory treatment
  1. Abbreviations: ALI: Acute Lung Injury, ARDS: Acute Respiratory Distress Syndrome, BAL: Bronchoalveolar Lavage, KL-6: Krebs von den Lungen-6, ROC: Receiver Operating Characteristic, SP: Surfactant Protein, a: Use the American European Consensus Conference definitions