Plasma Concentrations of Soluble Suppression of Tumorigenicity-2 and Interleukin-6 Are Predictive of Successful Liberation From Mechanical Ventilation in Patients With the Acute Respiratory Distress Syndrome*. Issue 9 (September 2016)

• Record Type: Journal Article
• Authors: Alladina, Jehan W.; Levy, Sean D.; Hibbert, Kathryn A.; Januzzi, James L.; Harris, R. Scott; Matthay, Michael A.; Thompson, B. Taylor; Bajwa, Ednan K.
• Is Part Of: Critical care medicine. Volume 44:Issue 9(2016)
• Publication Date: 2016-09
• Subjects: acute respiratory distress syndrome -- biomarkers -- critical care -- interleukin-6 protein, human -- mechanical ventilation -- mechanical ventilator weaning -- suppression of tumorigenicity-2 protein, human; Critical care medicine -- Periodicals; Soins intensifs -- Périodiques; 616.028
• DOI: 10.1097/CCM.0000000000001814
• Languages: English
• ISSNs: 0090-3493

Abstract

Abstract : Objectives: Soluble suppression of tumorigenicity-2 and interleukin-6 concentrations have been associated with the inflammatory cascade of acute respiratory distress syndrome. We determined whether soluble suppression of tumorigenicity-2 and interleukin-6 levels can be used as prognostic biomarkers to guide weaning from mechanical ventilation and predict the need for reintubation. Design, Setting, and Patients: We assayed plasma soluble suppression of tumorigenicity-2 ( n = 826) concentrations and interleukin-6 ( n = 755) concentrations in the Fluid and Catheter Treatment Trial, a multicenter randomized controlled trial of conservative fluid management in acute respiratory distress syndrome. We tested whether soluble suppression of tumorigenicity-2 and interleukin-6 levels were associated with duration of mechanical ventilation, the probability of passing a weaning assessment, and the need for reintubation. Measurements and Main Results: In models adjusted for Acute Physiology and Chronic Health Evaluation score and other relevant variables, patients with higher day 0 and day 3 median soluble suppression of tumorigenicity-2 and interleukin-6 concentrations had decreased probability of extubation over time (day 0 soluble suppression of tumorigenicity-2: hazard ratio, 0.85; 95% CI, 0.72–1.00; p = 0.05; day 0 interleukin-6: hazard ratio, 0.64; 95% CI, 0.54–0.75; p < 0.0001; day 3 soluble suppression of tumorigenicity-2: hazard ratio, 0.64; 95% CI, 0.54–0.75; p < 0.0001; and day 3 interleukin-6: hazard ratio, 0.73; 95% CI, 0.62–0.85; p = 0.0001). Higher biomarker concentrations were also predictive of decreased odds of passing day 3 weaning assessments (soluble suppression of tumorigenicity-2: odds ratio, 0.62: 95% CI, 0.44–0.87; p = 0.006 and interleukin-6: odds ratio, 0.61; 95% CI, 0.43–0.85; p = 0.004) and decreased odds of passing a spontaneous breathing trial (soluble suppression of tumorigenicity-2: odds ratio, 0.45; 95% CI, 0.28–0.71; p = 0.0007 and interleukin-6 univariate analysis only: odds ratio, 0.55; 95% CI, 0.36–0.83; p = 0.005). Finally, higher biomarker levels were significant predictors of the need for reintubation for soluble suppression of tumorigenicity-2 (odds ratio, 3.23; 95% CI, 1.04–10.07; p = 0.04) and for interleukin-6 (odds ratio, 2.58; 95% CI, 1.14–5.84; p = 0.02). Conclusions: Higher soluble suppression of tumorigenicity-2 and interleukin-6 concentrations are each associated with worse outcomes during weaning of mechanical ventilation and increased need for reintubation in patients with acute respiratory distress syndrome. Biomarker-directed ventilator management may lead to improved outcomes in weaning of mechanical ventilation in patients with acute respiratory distress syndrome.