Significance of von Willebrand factor in septic and nonseptic patients with acute lung injury.

Pubmed ID: 15201135

Journal: American journal of respiratory and critical care medicine

Publication Date: Oct. 1, 2004

Affiliation: Division of Allergy, Pulmonary and Critical Care Medicine, T1217 MCN, Vanderbilt University School of Medicine, Nashville, TN 37232-2650, USA. lorraine.ware@vanderbilt.edu

MeSH Terms: Humans, Male, Female, Aged, Case-Control Studies, Multicenter Studies as Topic, United States, Logistic Models, Middle Aged, Survival Analysis, Randomized Controlled Trials as Topic, Treatment Outcome, Multivariate Analysis, Prognosis, Time Factors, Predictive Value of Tests, Linear Models, Respiration, Artificial, APACHE, Sepsis, von Willebrand Factor, Multiple Organ Failure, Systemic Inflammatory Response Syndrome, Biomarkers, Respiratory Distress Syndrome

Grants: HL 51856, HL 70521, 46054, 46055, 46056, 46057, 46058, 46059, 46060, 46061, 46062, 46063, 46064

Authors: Thompson BT, Parsons PE, Matthay MA, Ware LB, Eisner MD

Cite As: Ware LB, Eisner MD, Thompson BT, Parsons PE, Matthay MA. Significance of von Willebrand factor in septic and nonseptic patients with acute lung injury. Am J Respir Crit Care Med 2004 Oct 1;170(7):766-72. Epub 2004 Jun 16.

Studies:

Abstract

Systemic endothelial activation and injury are important causes of multiorgan system failure. We hypothesized that plasma levels of von Willebrand factor (VWF), a marker of endothelial activation and injury, would be associated with clinical outcomes in acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). In 559 patients with ALI/ARDS enrolled in the National Heart, Lung, and Blood Institute ARDS Network trial of two VT strategies, plasma VWF levels were measured at randomization (mean 350 +/- 265% of normal control plasma) and Day 3 (344 +/- 207%). Baseline VWF levels were similar in patients with and without sepsis, and were significantly higher in nonsurvivors (435 +/- 333%) versus survivors (306 +/- 209%) even when controlling for severity of illness, sepsis, and ventilator strategy (increased odds ratio of death of 1.6 per SD size increase in VWF; 95% confidence interval, 1.4-2.1). Higher VWF levels were also significantly associated with fewer organ failure-free days. Ventilator strategy had no effect on VWF levels. In conclusion, the degree of endothelial activation and injury is strongly associated with outcomes in ALI/ARDS, regardless of the presence or absence of sepsis, and is not modulated by a protective ventilatory strategy. To improve outcomes further, new treatment strategies targeted at the endothelium should be investigated.