Abstract | BACKGROUND: METHODS: This was a substudy of the observational FINNALI study conducted in 25 Finnish intensive care units over an 8-week period. All patients older than 16 years requiring mechanical ventilation for >6 hours were included. MMP-8 and TIMP-1 levels were analyzed from blood samples taken on enrollment in the study and 48 hours later. Laboratory analyses were performed by using immunofluorometric assay for MMP-8 and ELISA for TIMP-1. MMP-8 and TIMP-1 levels were compared between 90-day survivors and nonsurvivors. Survival was compared in quartiles based on TIMP-1 levels, and ROC analysis was performed to calculate areas under the curves. The relationship between MMP-8 and TIMP-1 levels and degree of hypoxemia was examined. RESULTS: The final analyses included 563 patients. Admission TIMP-1 levels were higher in nonsurvivors, median 367 ng/mL (interquartile range 199-562), than survivors, median 240 ng/mL (interquartile range 142-412), WMWodds 1.68 (95% confidence interval [CI], 1.43-2.08). MMP-8 levels may have differed between survivors and nonsurvivors, WMWodds 1.20 (95% CI, 1.01-1.43), but no difference was found in the MMP-8/TIMP-1 molar ratio, WMWodds 0.83 (95% CI, 0.67-1.04). Difference in survival between quartiles based on TIMP-1 was significant (log-rank, P < 0.001). ROC analysis produced an area under the curve 0.63 (95% CI, 0.58-0.69) for TIMP-1. TIMP-1 was associated with severity of hypoxemia. TIMP-1 levels were higher in an ARDS subgroup than in the whole cohort, WMWodds 1.65 (95% CI, 1.15-2.44). CONCLUSIONS: MMP-8 levels were possibly higher in 90-day nonsurvivors but performed poorly in predicting outcome. Increased systemic levels of TIMP-1 were associated with more severe hypoxemia and worse outcome in a large cohort of mechanically ventilated critically ill patients and in a subgroup of ARDS patients.
|
Authors | Johanna Hästbacka, Rita Linko, Taina Tervahartiala, Tero Varpula, Seppo Hovilehto, Ilkka Parviainen, Suvi T Vaara, Timo Sorsa, Ville Pettilä |
Journal | Anesthesia and analgesia
(Anesth Analg)
Vol. 118
Issue 4
Pg. 790-8
(Apr 2014)
ISSN: 1526-7598 [Electronic] United States |
PMID | 24651234
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
|
Chemical References |
- Biomarkers
- TIMP1 protein, human
- Tissue Inhibitor of Metalloproteinase-1
- MMP8 protein, human
- Matrix Metalloproteinase 8
|
Topics |
- Acute Disease
- Aged
- Biomarkers
(blood)
- Cohort Studies
- Critical Illness
(mortality)
- Cross Infection
(blood, mortality)
- Elective Surgical Procedures
- Emergency Medical Services
- Endpoint Determination
- Female
- Hospital Mortality
- Humans
- Male
- Matrix Metalloproteinase 8
(blood)
- Middle Aged
- ROC Curve
- Respiration, Artificial
- Respiratory Distress Syndrome
(blood, mortality)
- Respiratory Function Tests
- Respiratory Insufficiency
(blood, mortality)
- Sepsis
(blood, mortality)
- Survivors
- Tissue Inhibitor of Metalloproteinase-1
(blood)
|