الفهرس 
• Historical Perspective of ALI and ARDSOnly 14 pages are availabe for public view
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Abstract
Background: Acute lung injury (ALI) and its severe form, acute respiratory distress syndrome (ARDS), continue to be significant challenges with persistent refractory hypoxemia resulting in respiratory failure. Hundreds of xenobiotics are well known to cause direct respiratory insults with subsequent ALI or ARDS. Among these xenobiotics, toxic inhalants, organophosphorus compounds, opiates, salicylates and cocaine come at the top of the list. ARDS activates cellular and molecular cascades that result in circulating inflammatory and pro-thrombotic mediators as well as pathophysiologic disturbances that may be important determinants of mortality. Pentraxin 3 (PTX3) and C-reactive protein (CRP) are acute-phase proteins, acting as inflammatory mediators in response to pro-inflammatory signals. CRP is produced by the liver while PTX3 is produced by macrophages, fibroblasts, endothelial cells and smooth muscle cells. High serum PTX3 and CRP levels have been associated with increasing mortality in ARDS. Aim of the study: to evaluate and compare the role of PTX3 and CRP as early predictors of severity and outcome in ALI/ARDS. Patients and methods: This cross-sectional observational study was carried out on 50 acutely intoxicated patients who were admitted to the ICU of Poison Control Center of Ain Shams University hospitals (PCCA), and intubated with suspected acute lung injury (according to lung injury score). Patients were then sub-classified according to their outcome into 2 groups, group (1): Survivors, included 22 patients representing 44% of the total number of patients. group (2): Non-survivors, included 28 patients representing 56% of the total number of patients. PTX3 and CRP were measured in the studied patients within the 1st 24 hours after endotracheal intubation, and repeated after 24 hours from the initial sample. A third sample was taken after 3 days from the second one. Results: All mean values of PTX3 were significantly higher among non survivors compared to survivors with a peak on day (1). Its levels dropped on day (2) and day (5), but they did not return to the normal values. CRP levels started to increase on the 2nd day and continued on the 5th day being significantly much higher among non survivors than survivors. At cut off value of 5.5 ng/ml, PTX3 was 100% sensitive and specific on day (1) compared to 75% sensitive and 50% specific CRP. Both biomarkers were inversely correlated on all days among both groups. Conclusions: The crucial role of plasma PTX3 was noticed in predicting the outcome of ALI in acutely intoxicated patients, showing 100% sensitivity and specificity.
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