Abstract | OBJECTIVE: DESIGN: Retrospective analysis. SETTING: Four intensive care units. SUBJECTS: Seventy-nine of 91 patients with available samples enrolled in a randomized, blinded controlled trial. INTERVENTIONS: MEASUREMENTS AND MAIN RESULTS:
Interleukin-6, tumor necrosis factor α, vascular endothelial growth factor, protein C, procalcitonin, and proadrenomedullin were measured in archived plasma. Changes from baseline to day 3 and day 7 were compared between groups and in subgroups based on the precipitating cause of acute respiratory distress syndrome. Methylprednisolone therapy was associated with greater improvement in Lung Injury Score (p = .003), shorter duration of mechanical ventilation (p = .005), and lower intensive care unit mortality (p = .05) than control subjects. On days 3 and 7, methylprednisolone decreased interleukin-6 and increased protein C levels (all p < .0001) compared with control subjects. Proadrenomedullin levels were lower by day 3 with methylprednisolone treatment (p = .004). Methylprednisolone decreased interleukin-6 by days 3 and 7 in patients with pulmonary causes of acute respiratory distress syndrome but only at day 3 in those with extrapulmonary causes of acute respiratory distress syndrome. Protein C levels were increased with methylprednisolone on days 3 and 7 in patients with infectious and/or pulmonary causes of acute respiratory distress syndrome (all p < .0001) but not in patients with noninfectious or extrapulmonary causes of acute respiratory distress syndrome. Proadrenomedullin levels were decreased with methylprednisolone on day 3 in patients with infectious or extrapulmonary causes of acute respiratory distress syndrome (both p ≤ .008) but not in noninfectious or pulmonary acute respiratory distress syndrome. Tumor necrosis factor, vascular endothelial growth factor, and procalcitonin were elevated but not differentially affected by methylprednisolone therapy. CONCLUSIONS:
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Authors | Nitin Seam, G Umberto Meduri, Honghui Wang, Eric S Nylen, Junfeng Sun, Marcus J Schultz, Margaret Tropea, Anthony F Suffredini |
Journal | Critical care medicine
(Crit Care Med)
Vol. 40
Issue 2
Pg. 495-501
(Feb 2012)
ISSN: 1530-0293 [Electronic] United States |
PMID | 21983371
(Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, N.I.H., Intramural)
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Chemical References |
- Inflammation Mediators
- Interleukin-6
- Methylprednisolone
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Topics |
- Blood Coagulation
(drug effects, physiology)
- Critical Care
(methods)
- Dose-Response Relationship, Drug
- Double-Blind Method
- Drug Administration Schedule
- Early Diagnosis
- Female
- Follow-Up Studies
- Hospital Mortality
- Humans
- Inflammation Mediators
(analysis, metabolism)
- Infusions, Intravenous
- Interleukin-6
(metabolism)
- Male
- Methylprednisolone
(administration & dosage)
- Middle Aged
- Neovascularization, Physiologic
(drug effects)
- Predictive Value of Tests
- Prospective Studies
- Reference Values
- Respiratory Distress Syndrome
(diagnosis, drug therapy, metabolism, mortality)
- Risk Assessment
- Severity of Illness Index
- Statistics, Nonparametric
- Survival Rate
- Time Factors
- Treatment Outcome
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