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Official Journal of the Italian Society of Thoracic Endoscopy
Indexed/Abstracted in: EMBASE, Scopus
Online ISSN 1827-1723
Sinclair S. E., Golden E. B., Carratu P., John B. E., R. Umberger A., Meduri G. U.
Memphis Lung Research Program Division of Pulmonary, Critical Care, and Sleep Medicine at the University of Tennessee Health Science Center, Memphis, TN, USA
Aim. Interleukin-8 (IL-8) and intercellular adhesion molecule-1 (ICAM-1) promote migration and activation of neutrophils in the lung. We investigated the longitudinal relationship between circulating and bronchoalveolar lavage (BAL) levels of IL-8 and sICAM-1 during acute respiratory distress syndrome (ARDS) and in response to prolonged methylprednisolone (MP) treatment. Design. Prospective observational study, and prospective double-blind placebo controlled randomized study. Setting: Univer-sity Medical Center.
Methods. We studied 28 29 medical and surgical patients with ARDS. A reduction in lung injury score (LIS) > 1 point from day 1 to day 7 of ARDS divided patients into improvers (group 1, n=7) and nonimprovers (n=21). Nonim-provers included those (group 2, n=17) randomized to MP treatment vs placebo, and those who died prior to ARDS day 10 (group 3, n=4). All improvers survived. Interventions: We obtained serial measurements of plasma and BAL IL-8 and sICAM-1 levels, and components of the LIS.
Results. At ARDS onset, improvers had lower IL-8 levels in the plasma and lower sICAM-1 levels in plasma and BAL. By ARDS day 10, plasma IL-8 remained persistently elevated in nonimprovers but declined in improvers (p<0.0001); whereas plasma sICAM-1 levels increased in nonimprovers (p<0.0001). BAL IL-8 levels correlated with BAL neutrophilia (r=0.56624, p= 0.02). MP treatment was associated with a reduction in IL-8 and sICAM-1 levels in plasma (by day 5, p<0.0001) and BAL (by days 8-15, p<0.0001).
Conclusion. We provide additional evidence for the biological efficacy of MP treatment in unresolving ARDS.