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Lin H, Liu Q, Zhao L, Liu Z, Cui H, Li P, Fan H, Guo L. Circulating Pulmonary-Originated Epithelial Biomarkers for Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis. Int J Mol Sci 2023; 24:ijms24076090. [PMID: 37047065 PMCID: PMC10093822 DOI: 10.3390/ijms24076090] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/07/2023] [Accepted: 03/20/2023] [Indexed: 04/14/2023] Open
Abstract
Previous studies have found several biomarkers for acute respiratory distress syndrome (ARDS), but the accuracy of most biomarkers is still in doubt due to the occurrence of other comorbidities. In this systematic review and meta-analysis, we aimed to explore ideal ARDS biomarkers which can reflect pathophysiology features precisely and better identify at-risk patients and predict mortality. Web of Science, PubMed, Embase, OVID, and the Cochrane Library were systematically searched for studies assessing the reliability of pulmonary-originated epithelial proteins in ARDS. A total of 32 studies appeared eligible for meta-analysis, including 2654 ARDS/ALI patients in this study. In the at-risk patients' identification group, the highest pooled effect size was observed in Krebs von den Lungren-6 (KL-6) (SMD: 1.17 [95% CI: 0.55, 1.79]), followed by club cell proteins 16 (CC16) (SMD: 0.74 [95% CI: 0.01, 1.46]), and surfactant proteins-D (SP-D) (SMD: 0.71 [95% CI: 0.57, 0.84]). For the mortality prediction group, CC16 exhibited the largest effect size with SMD of 0.92 (95% CI: 0.42, 1.43). Meanwhile, the summary receiver operating characteristic (SROC) of CC16 for ARDS diagnosis reached an AUC of 0.80 (95% CI: 0.76, 0.83). In conclusion, this study provides a ranking system for pulmonary-originated epithelial biomarkers according to their association with distinguishing at-risk patients and predicting mortality. In addition, the study provides evidence for the advantage of biomarkers over traditional diagnostic criteria. The performance of biomarkers may help to clinically improve the ARDS diagnosis and mortality prediction.
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Affiliation(s)
- Huishu Lin
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China
- Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou 325000, China
- Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin 300072, China
| | - Qisijing Liu
- Research Institute of Public Health, School of Medicine, Nankai University, Tianjin 300381, China
| | - Lei Zhao
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China
- Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou 325000, China
- Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin 300072, China
| | - Ziquan Liu
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China
- Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou 325000, China
- Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin 300072, China
| | - Huanhuan Cui
- Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou 325000, China
| | - Penghui Li
- School of Environmental Science and Safety Engineering, Tianjin University of Technology, Tianjin 300384, China
| | - Haojun Fan
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China
- Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou 325000, China
- Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin 300072, China
| | - Liqiong Guo
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China
- Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou 325000, China
- Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin 300072, China
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Almuntashiri S, Chase A, Sikora A, Zhang D. Validation of Prognostic Club Cell Secretory Protein (CC16) Cut-point in an Independent ALTA Cohort. Biomark Insights 2023; 18:11772719231156308. [PMID: 36814995 PMCID: PMC9940244 DOI: 10.1177/11772719231156308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/23/2023] [Indexed: 02/19/2023] Open
Abstract
Background Club cell secretory protein (CC16) has demonstrated utility as a lung-specific biomarker in predicting mortality in acute respiratory distress syndrome (ARDS). These findings have been observed in pre-clinical trials and a re-analysis of a large, randomized controlled trial of ARDS (Fluid and Catheter Treatment Trial (FACTT)). Objectives The purpose of this study was to validate previous findings by evaluating CC16 level as a mortality predictor in patients from the albuterol to treat acute lung injury (ALTA) trial. Design and Method In this secondary biomarker analysis, plasma CC16 level was measured from 100 ALTA subjects using enzyme-linked immunosorbent assay (ELISA). The rate of mortality was assessed in patients with high (⩾45 ng/mL) versus low CC16 (<45 ng/mL) levels. This cut-off level was applied based on our previous analysis from FACTT trial. Significance was assessed using Kaplan-Meier curves and a log-rank test. Results Subjects were an average of 50 years old and 46% of them were females. Patients with high CC16 levels had higher 90-day mortality compared to those with low CC16 levels, (37.73% vs 8.95%, P < .001). Other clinical outcomes including ICU-free days, ventilator-free days, and organ failure free days were significantly different between the groups (All P < .05). Conclusion In this validation study, we demonstrated that ARDS patients with high plasma CC16 concentration had a higher mortality rate than those with low CC16 levels, confirming previous findings that CC16 levels are associated with ARDS mortality.
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Affiliation(s)
- Sultan Almuntashiri
- Clinical and Experimental Therapeutics, College of Pharmacy, University of Georgia and Charlie Norwood VA Medical Center, Augusta, GA, USA.,Department of Clinical Pharmacy, College of Pharmacy, University of Hail, Hail, Saudi Arabia
| | - Aaron Chase
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Augusta, GA, USA.,Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA
| | - Andrea Sikora
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Augusta, GA, USA.,Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA
| | - Duo Zhang
- Clinical and Experimental Therapeutics, College of Pharmacy, University of Georgia and Charlie Norwood VA Medical Center, Augusta, GA, USA.,Department of Medicine, Augusta University, Augusta, GA, USA
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Club Cell Secretory Protein-Derived Acute Respiratory Distress Syndrome Phenotypes Predict 90-Day Mortality: A Reanalysis of the Fluids and Catheter Treatment Trial. Crit Care Explor 2022; 4:e0711. [PMID: 35651737 PMCID: PMC9150885 DOI: 10.1097/cce.0000000000000711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Club cell secretory protein (CC16) is a protein with potential utility as a lung-specific biomarker for acute respiratory distress syndrome. The purpose of this study was to characterize CC16 in plasma from patients enrolled in the Fluid and Catheter Treatment Trial (FACTT) to determine the prognostic value for patient outcomes in our subgroup of FACTT patients.
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Tiezzi M, Morra S, Seminerio J, Van Muylem A, Godefroid A, Law-Weng-Sam N, Van Praet A, Corbière V, Orte Cano C, Karimi S, Del Marmol V, Bondue B, Benjelloun M, Lavis P, Mascart F, van de Borne P, Cardozo AK. SP-D and CC-16 Pneumoproteins' Kinetics and Their Predictive Role During SARS-CoV-2 Infection. Front Med (Lausanne) 2022; 8:761299. [PMID: 35211479 PMCID: PMC8863171 DOI: 10.3389/fmed.2021.761299] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/07/2021] [Indexed: 12/12/2022] Open
Abstract
Background Surfactant protein D (SP-D) and pulmonary club cell protein 16 (CC-16) are called “pneumoproteins” and are involved in host defense against oxidative stress, inflammation, and viral outbreak. This study aimed to determine the predictive value of these pneumoproteins on the incidence of acute respiratory distress syndrome (ARDS) or death in patients with coronavirus disease-2019 (COVID-19). Methods This retrospective study included 87 patients admitted to an emergency department. Blood samples were collected on three time points (days 1, 5, and 14 from hospital admission). SP-D and CC-16 serum levels were determined, and univariate and multivariate analyses considering confounding variables (age, body mass index, tobacco use, dyspnea, hypertension, diabetes mellitus, neutrophil-to-lymphocyte ratio) were performed. Results Based on the multivariate analysis, SP-D level on D1 was positively and slightly correlated with subsequent development of ARDS, independent of body mass index, dyspnea, and diabetes mellitus. CC-16 level on D1 was modestly and positively correlated with fatal outcome. A rise in SP-D between D1 and D5 and D1 and D14 had a strong negative association with incidence of ARDS. These associations were independent of tobacco use and neutrophil-to-lymphocyte ratio. Conclusions Overall, our data reveal that increase in SP-D levels is a good prognostic factor for patients with COVID-19, and that initial CC-16 levels correlated with slightly higher risk of death. SP-D and CC-16 may prove useful to predict outcomes in patients with COVID-19.
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Affiliation(s)
- Margherita Tiezzi
- Department of Cardiology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.,Inflammation and Cell Death Signalling Group, Experimental Gastroenterology Laboratory and Endotools-Medical Faculty, ULB, Brussels, Belgium
| | - Sofia Morra
- Department of Cardiology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.,Institute for Translational Research in Cardiovascular and Respiratory Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | - Jimmy Seminerio
- Department of Cardiology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Alain Van Muylem
- Department of Respiratory Medicine, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Audrey Godefroid
- Laboratory of Vaccinology and Mucosal Immunity, Université Libre de Bruxelles, Brussels, Belgium
| | - Noémie Law-Weng-Sam
- Laboratory of Vaccinology and Mucosal Immunity, Université Libre de Bruxelles, Brussels, Belgium
| | - Anne Van Praet
- Laboratory of Vaccinology and Mucosal Immunity, Université Libre de Bruxelles, Brussels, Belgium
| | - Véronique Corbière
- Laboratory of Vaccinology and Mucosal Immunity, Université Libre de Bruxelles, Brussels, Belgium
| | - Carmen Orte Cano
- Department of Dermatology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Sina Karimi
- Department of Internal Medicine, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Véronique Del Marmol
- Department of Dermatology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Benjamin Bondue
- Department of Respiratory Medicine, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Mariam Benjelloun
- Department of Cardiology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.,Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Philomène Lavis
- Department of Pathology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Françoise Mascart
- Laboratory of Vaccinology and Mucosal Immunity, Université Libre de Bruxelles, Brussels, Belgium.,Immunobiology Clinic, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium
| | - Philippe van de Borne
- Department of Cardiology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.,Institute for Translational Research in Cardiovascular and Respiratory Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | - Alessandra K Cardozo
- Inflammation and Cell Death Signalling Group, Experimental Gastroenterology Laboratory and Endotools-Medical Faculty, ULB, Brussels, Belgium
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Lin J, Tao W, Wei J, Wu J, Zhang W, Ye J, Fu X, Zeng S, Dou Q, Wang L, Tian F. Correction to: Renal dysfunction reduces the diagnostic and prognostic value of serum CC16 for acute respiratory distress syndrome in intensive care patients. BMC Pulm Med 2021; 21:54. [PMID: 33563255 PMCID: PMC7871561 DOI: 10.1186/s12890-021-01417-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jinle Lin
- Department of Emergency Medicine, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, 118 LongjingEr Road, Baoan, Shenzhen, 518101, Guangdong, China.,Department of Respiratory, East Zone Sixth Division, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangdong Provincial Geriatrics Institute, The second School of Clinical Medicine, Southern Medical University, No. 106, Zhongshan Second Road, Guangzhou, 510000, Guangdong, China
| | - Wuyuan Tao
- Department of Emergency Medicine, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, 118 LongjingEr Road, Baoan, Shenzhen, 518101, Guangdong, China.,Department of Respiratory, East Zone Sixth Division, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangdong Provincial Geriatrics Institute, The second School of Clinical Medicine, Southern Medical University, No. 106, Zhongshan Second Road, Guangzhou, 510000, Guangdong, China
| | - Jian Wei
- Department of Emergency Medicine, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, 118 LongjingEr Road, Baoan, Shenzhen, 518101, Guangdong, China
| | - Jian Wu
- Department of Respiratory, East Zone Sixth Division, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangdong Provincial Geriatrics Institute, The second School of Clinical Medicine, Southern Medical University, No. 106, Zhongshan Second Road, Guangzhou, 510000, Guangdong, China.
| | - Wenwu Zhang
- Department of Emergency Medicine, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, 118 LongjingEr Road, Baoan, Shenzhen, 518101, Guangdong, China.
| | - Jianbing Ye
- Department of Emergency Medicine, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, 118 LongjingEr Road, Baoan, Shenzhen, 518101, Guangdong, China
| | - Xuan Fu
- Department of Emergency Medicine, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, 118 LongjingEr Road, Baoan, Shenzhen, 518101, Guangdong, China
| | - Shiyong Zeng
- Department of Emergency Medicine, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, 118 LongjingEr Road, Baoan, Shenzhen, 518101, Guangdong, China
| | - Qingli Dou
- Department of Emergency Medicine, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, 118 LongjingEr Road, Baoan, Shenzhen, 518101, Guangdong, China
| | - Lijun Wang
- Department of Critical Care Medicine, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, Shenzhen, 518101, Guangdong, China
| | - Fang Tian
- Department of Critical Care Medicine, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, Shenzhen, 518101, Guangdong, China
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