UK urges more flexibility in criteria for flu pandemic alertsBMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b2067 (Published 21 May 2009) Cite this as: BMJ 2009;338:b2067
All rapid responses
The severity biomarkers of ARDS may provide means for monitoring
severity of influenza A/H1N1
To The Editor: Influenza A/H1N1 ranges in severity from minor non-specific
symptoms to life threatening disease. In life threatening respiratory
cases influenza manifests clinically as pneumonia and progresses into
acute respiratory distress syndrome (ARDS). The strike is now, with the
exception of the outbreak in Mexico, which is still not fully understood,
the H1N1 virus tends to cause very mild illness in otherwise healthy
people. It is difference compare with avian influenza H5N1 or SARS. This
is not surprising because of influenza viruses are that mutations occur
frequently and unpredictably in the eight gene segments, and especially in
the haemagglutinin gene. The importance is determinant of the severity of
an influenza pandemic; the number of cases of severe illness, deaths it
causes and also predict the severity biomarkers, such as development of
ARDS in order to differentiate groups of patients at highest risk for
adverse clinical outcomes and additional information needed for raising
flu pandemic alerts to highest level by local regional or words disease
control office (BMJ 2009;338:b2067).
Several biomarkers of ARDS mortality have been identified in trials
NIH ARDS Network of protective ventilatory strategy. These markers include
alveolar epithelial marker surfactant protein D (SP-D), the endothelial
Willebrand Factor antigen, coagulation and fibrinolysis proteins; protein
plasminogen activator inhibitor-1, D-dimer (2), interleukins 6 and and
interleukins 8, and soluble TNF receptors (1). SP-D is a defense lectin
promoting viral clearance by
enhancement of phagocytosis. The synthesis is located primarily to the
epithelium and systemic SP-D is widely used as a marker of alveolar
Von Willebrand factor is a marker of endothelial activation and injury.
systemic levels of SP-D and von Willebrand factor antigen were associated
worse clinical outcomes in ARDS, including a greater risk of death, fewer
days, and fewer organ failure-free days (1,4). Systemic levels of both
demonstrated disturbed in viral pneumonia (5,6). The combination of these
biomarkers may have important and additive value in predictive models for
influenza A/H1N1 and rapid assays for clinical tests are available.
Bin. Zhang, Department of Oral Medicine, Liaocheng People’s Hospital,
Liaocheng Medical College, Taishan Medical University, China.
Ya Ping. Wu, Clinical Chemistry and Haematology University Medical
Uffe. Holmskov, Medical Biotechnology Center Institute for Medical
Biology University of
Shao Dong. Pan, Liaocheng People’s Hospital, Liaocheng Medical
College, Taishan Medical University,
Philip G. de Groot, Clinical Chemistry and Haematology University
Medical Center Utrecht,
Grith L. Sorensen, Medical Biotechnology Center Institute for Medical
Biology University of
1. Ware LB. Prognostic determinants of acute respiratory distress syndrome
impact on clinical trial design. Crit Care Med. 2005;33:S217-22.
2. SARS in Hong Kong. Wu YP, Wei R, de Groot PG. N Engl J Med. 2003 Aug
3. Sorensen GL, Husby S, Holmskov U. Surfactant protein A and surfactant
variation in pulmonary disease. Immunobiology. 2007;212:381-416.
4. Eisner MD, Parsons P, Matthay MA, Ware L, Greene K; Acute Respiratory
Distress Syndrome Network. Plasma surfactant protein levels and clinical
patients with acute lung injury. Thorax. 2003;58:983-8.
5. Wu YP, Wei R, Liu ZH, Chen B, Lisman T, Ren DL, Han JJ, Xia ZL, Zhang
Xu WB, Preissner KT, de Groot PG. Analysis of thrombotic factors in severe
respiratory syndrome (SARS) patients. Thromb Haemost. 2006;96:100-1.
Thromb Haemost. 2006;96(4):543. Zhang, Fu Sheng [corrected to Zhang, Fu
6. Wu YP, Liu ZH, Wei R, Pan SD, Mao NY, Chen B, Han JJ, Zhang FS,
U, Xia ZL, de Groot PG, Reid KBM, Xu WB, Sorensen GL, Elevated plasma
Surfactant protein D (SP-D) level and a direct correlation to anti severe
respiratory syndrome coronavirus (SARS-CoV) specific IgG antibody in SARS
patients. Scand J Immunol. 2009; 69: 508-515.
Competing interests: No competing interests