Higher urine desmosine levels are associated with mortality in patients with acute lung injury.
Pubmed ID: 16698854
Pubmed Central ID: PMC2765125
Journal: American journal of physiology. Lung cellular and molecular physiology
Publication Date: 10/01/2006
Affiliation: Cardiovascular Research Institute, University of California, San Francisco, CA 94143-0130, and Pulmonary and Critical Care Unit, Department of Medicine, Massachusetts General Hospital, Boston, USA. firstname.lastname@example.org
MeSH Terms: Humans, Male, Adult, Female, Aged, Middle Aged, Clinical Trials as Topic, Severity of Illness Index, Time Factors, Predictive Value of Tests, Respiration, Artificial, Tidal Volume, Desmosine, Tissue Survival, Ultrasonography, Respiratory Distress Syndrome
Grants: N01-HR-46059, P50-HL-74006, R01-HL-51856, R37 HL051856, R37 HL051856-14, R01 HL051856, N01HR46059
Authors: Thompson BT, Matthay MA, Eisner MD, McClintock DE, Starcher B, Hayden DL, Church GD
Cite As: McClintock DE, Starcher B, Eisner MD, Thompson BT, Hayden DL, Church GD, Matthay MA, National Heart Lung Blood Institute Acute Respiratory Distress Syndrome Clinical Trials Network. Higher urine desmosine levels are associated with mortality in patients with acute lung injury. Am J Physiol Lung Cell Mol Physiol 2006 Oct;291(4):L566-71. Epub 2006 May 12.
Desmosine is a stable breakdown product of elastin that can be reliably measured in urine samples. We tested the hypothesis that higher baseline urine desmosine would be associated with higher mortality in 579 of 861 patients included in the recent Acute Respiratory Distress Syndrome Network trial of lower tidal volume ventilation (1). We also correlated urine desmosine levels with indexes of disease severity. Finally, we assessed whether urine desmosine was lower in patients who received lower tidal volumes. Desmosine was measured by radioimmunoassay in urine samples from days 0, 1, and 3 of the study. The data were expressed as a ratio of urine desmosine to urine creatinine to control for renal dilution. The results show that higher baseline (day 0) urine desmosine-to-creatinine concentration was associated with a higher risk of death on adjusted analysis (odds ratio 1.36, 95% confidence interval 1.02-1.82, P=0.03). Urine desmosine increased in both ventilator groups from day 0 to day 3, but the average rise was higher in the 12-ml/kg predicted body weight group compared with the 6-ml/kg predicted body weight group (P=0.053, repeated-measures model). In conclusion, patients with acute lung injury ventilated with lower tidal volumes have lower urine desmosine levels, a finding that may reflect reduced extracellular matrix breakdown. These results illustrate the value of evaluating urinary biological markers that may have prognostic and pathogenetic significance in acute lung injury.