The severity biomarkers of ARDS may provide means for monitoring severity of influenza A/H1N1
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
performed by
NIH ARDS Network of protective ventilatory strategy. These markers include
the
alveolar epithelial marker surfactant protein D (SP-D), the endothelial
marker von
Willebrand Factor antigen, coagulation and fibrinolysis proteins; protein
C, and
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
pulmonary
epithelium and systemic SP-D is widely used as a marker of alveolar
integrity (3).
Von Willebrand factor is a marker of endothelial activation and injury.
Increased
systemic levels of SP-D and von Willebrand factor antigen were associated
with
worse clinical outcomes in ARDS, including a greater risk of death, fewer
ventilatorfree
days, and fewer organ failure-free days (1,4). Systemic levels of both
proteins are
demonstrated disturbed in viral pneumonia (5,6). The combination of these
biomarkers may have important and additive value in predictive models for
ARDS in
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
Center Utrecht,
Uffe. Holmskov, Medical Biotechnology Center Institute for Medical
Biology University of
Southern Denmark,
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
Southern Denmark,
References
1. Ware LB. Prognostic determinants of acute respiratory distress syndrome
in adults:
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
14;349(7):708-9.
3. Sorensen GL, Husby S, Holmskov U. Surfactant protein A and surfactant
protein D
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
outcomes in
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
FS,
Xu WB, Preissner KT, de Groot PG. Analysis of thrombotic factors in severe
acute
respiratory syndrome (SARS) patients. Thromb Haemost. 2006;96:100-1.
Erratum in:
Thromb Haemost. 2006;96(4):543. Zhang, Fu Sheng [corrected to Zhang, Fu
Sen].
6. Wu YP, Liu ZH, Wei R, Pan SD, Mao NY, Chen B, Han JJ, Zhang FS,
Holmskov
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
acute
respiratory syndrome coronavirus (SARS-CoV) specific IgG antibody in SARS
patients. Scand J Immunol. 2009; 69: 508-515.
Competing interests:
None declared
Competing interests:
No competing interests
29 May 2009
Bin Zhang
Professor
Bin. Zhang, Uffe. Holmskov, Ya Ping. Wu, Shao Dong. Pan, Philip G. de Groot, Grith L. Sorensen,
No.67 Dongchang West Road, Liaocheng City, Shandong Province, P. R. China 252000
Rapid Response:
The severity biomarkers of ARDS may provide means for monitoring severity of influenza A/H1N1
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
performed by
NIH ARDS Network of protective ventilatory strategy. These markers include
the
alveolar epithelial marker surfactant protein D (SP-D), the endothelial
marker von
Willebrand Factor antigen, coagulation and fibrinolysis proteins; protein
C, and
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
pulmonary
epithelium and systemic SP-D is widely used as a marker of alveolar
integrity (3).
Von Willebrand factor is a marker of endothelial activation and injury.
Increased
systemic levels of SP-D and von Willebrand factor antigen were associated
with
worse clinical outcomes in ARDS, including a greater risk of death, fewer
ventilatorfree
days, and fewer organ failure-free days (1,4). Systemic levels of both
proteins are
demonstrated disturbed in viral pneumonia (5,6). The combination of these
biomarkers may have important and additive value in predictive models for
ARDS in
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
Center Utrecht,
Uffe. Holmskov, Medical Biotechnology Center Institute for Medical
Biology University of
Southern Denmark,
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
Southern Denmark,
References
1. Ware LB. Prognostic determinants of acute respiratory distress syndrome
in adults:
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
14;349(7):708-9.
3. Sorensen GL, Husby S, Holmskov U. Surfactant protein A and surfactant
protein D
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
outcomes in
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
FS,
Xu WB, Preissner KT, de Groot PG. Analysis of thrombotic factors in severe
acute
respiratory syndrome (SARS) patients. Thromb Haemost. 2006;96:100-1.
Erratum in:
Thromb Haemost. 2006;96(4):543. Zhang, Fu Sheng [corrected to Zhang, Fu
Sen].
6. Wu YP, Liu ZH, Wei R, Pan SD, Mao NY, Chen B, Han JJ, Zhang FS,
Holmskov
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
acute
respiratory syndrome coronavirus (SARS-CoV) specific IgG antibody in SARS
patients. Scand J Immunol. 2009; 69: 508-515.
Competing interests:
None declared
Competing interests: No competing interests