Tuberc Respir Dis.  2009 Nov;67(5):402-408.

Clinical Utility of Pre-B-Cell Colony-Enhancing Factor in Bronchoalveolar Lavage Fluid of Acute Critical Ill Patients with Lung Infiltrates

Affiliations
  • 1Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. sbhong@amc.seoul.kr

Abstract

BACKGROUND
Pre-B-cell colony enhancing factor (PBEF) has been suggested as a novel biomarker in sepsis and acute lung injury. We measured the PBEF in bronchoalveolar lavage (BAL) fluid of acute critically ill patients with lung infiltrates in order to evaluate the clinical utility of measuring PBEF in BAL fluid.
METHODS
BAL fluid was collected by bronchoscope from 185 adult patients with lung infiltrates. An enzyme-linked immunosorbent assay was then performed on the collected fluids to measure the PBEF.
RESULTS
Mean patient age was 59.9+/-14.5 years and 63.8% of patients were males. The mean concentration of PBEF in BAL fluid was 17.5+/-88.3 ng/mL, and patients with more than 9 ng/mL of PBEF concentration (n=26, 14.1%) had higher Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores on the BAL exam day. However, there were no significant differences in clinical characteristics between survivors and non-survivors. In patients with leukocytosis (n=93) seen on the BAL exam day, the linear regression analysis revealed a significant, positive relationship between PBEF and APACHE II (r2=0.06), SOFA score (r2=0.08), Clinical Pulmonary Infection Score (r2=0.05), and plateau pressure in patients on ventilators (r2=0.07) (p<0.05, respectively). In addition, multivariate regression analysis with PBEF as a dependent variable showed that the plateau pressure (r2=0.177, p<0.05) was correlated positively with PBEF.
CONCLUSION
The PBEF level in the BAL fluid may be a useful, new biomarker for predicting the severity of illness and ventilator-induced lung injury in critically ill patients with lung infiltates and leukocytosis.

Keyword

Nicotinamide Phosphoribosyltransferase; Bronchoalveolar Lavage Fluid; Critical Illness; Lung Diseases

MeSH Terms

Acute Lung Injury
Adult
APACHE
Bronchoalveolar Lavage
Bronchoalveolar Lavage Fluid
Bronchoscopes
Critical Illness
Enzyme-Linked Immunosorbent Assay
Humans
Leukocytosis
Linear Models
Lung
Lung Diseases
Male
Nicotinamide Phosphoribosyltransferase
Precursor Cells, B-Lymphoid
Sepsis
Survivors
Ventilator-Induced Lung Injury
Ventilators, Mechanical
Nicotinamide Phosphoribosyltransferase

Figure

  • Figure 1 Distribution of PBEF concentration in bronchoalveolar lavage fluid.

  • Figure 2 Correlation between PBEF concentration and other clinical characteristics in patients with leukocytosis (total n=93). For statistic analyses, the PBEF levels in bronchoalveolar lavage (BAL) fluid were log-transformed in order to achieve a normal distribution. APACHE II: acute physiology and chronic health evaluation II; SOFA: sequential organ failure assessment; CPIS: clinical pulmonary infection score; PBEF: pre-B-cell colony enhancing factor; CI: confidential interval.


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