A systematic review of diagnostic methods to differentiate acute lung injury/acute respiratory distress syndrome from cardiogenic pulmonary edema

Komiya, Kosaku; Akaba, Tomohiro; Kozaki, Yuji; Kadota, Jun-ichi; Rubin, Bruce K.

doi:10.1186/s13054-017-1809-8

Critical Care

Table 2 Localized markers for differentiating ALI/ARDS from CPE

From: A systematic review of diagnostic methods to differentiate acute lung injury/acute respiratory distress syndrome from cardiogenic pulmonary edema

Study	Design	No. of ALI/ARDS vs CPE	Marker	Timing of measurement	Mean value ± SD/SEM or median (IQR or range) in ALI/ARDS	Mean value ± SD/SEM or median (IQR or range) in CPE	Unit	p value	AUC	95% CI	Cutoff	For	Specificity (%)	Sensitivity (%)
Markers of airway epithelium injury
Katayama, 2010*	Prospective	21 vs 11	Laminin gannma2 in ELF	Not stated	6034 ± 6245 SD	1237 ± 807 SD	ng/mL	<0.02	n.d.	n.d.	n.d.	n.d.	n.d.	n.d.
			Laminin gannma2 in plasma		147 ± 83 SD	35 ± 14 SD	ng/mL	<0.0001	n.d.	n.d.	n.d.	n.d.	n.d.	n.d.
Kropski, 2009*	Prospective	23 vs 9	CCP 16 in PEF	Within 24 h of diagnosis	1950 (IQR1780–4024)	4835 (IQR2006–6350)	ng/mL	0.044	n.d.	n.d.	n.d.	n.d.	n.d.	n.d.
			CCP 16 in serum		22 (IQR9–44)	55 (IQR18–123)	ng/mL	0.053	n.d.	n.d.	n.d.	n.d.	n.d.	n.d.
Chandel, 2009*	Prospective	15 vs 5	KGF in BAL	Within 48 h after intubation	1.2-fold ±0.12 SD	2.4-fold ±0.48 SD	fold	<0.01	n.d.	n.d.	n.d.	n.d.	n.d.	n.d.
Newman, 2000*	Prospective	15 vs 12	HTI56 in PEF	Within 15 min after intubation	1451 ± 6 727	335 ± 123	ug/mL	<0.0001	n.d.	n.d.	n.d.	n.d.	n.d.	n.d.
			HTI56 in plasma		217 ± 79	335 ± 123	ug/mL	<0.05	n.d.	n.d.	n.d.	n.d.	n.d.	n.d.
Shimura,1996*	Prospective	5 vs 11	SP-A in sputum	Not stated	311 ± 47 SEM	1324 ± 197 SEM	ug/mL	<0.001	n.d.	n.d.	n.d.	n.d.	n.d.	n.d.
Gunther, 1996*	Prospective	15 vs 13	SP-A in BAL	Within 72 h after intubation	849 ± 96 SEM	1013 ± 111 SEM	ng/mL	n.d.	n.d.	n.d.	n.d.	n.d.	n.d.	n.d.
			SP-B in BAL		867 ± 131 SEM	628 ± 42 SEM	ng/mL	n.d.	n.d.	n.d.	n.d.	n.d.	n.d.	n.d.
Protein ratio of fluid to plasma
Ware, 2010***	Prospective	209 vs 147	Fluid-to-plasma protein ratio	Not stated	0.89 ± 0.36 SD	0.53 ± 0.21 SD	n.d.	<0.001	0.84	0.79-0.88	0.65	ALI/ARDS	81	81
Colucci, 2009*	Prospective	18 vs 9	Protein ratio of fluid by s-Cath to plasma	Within 1–4 h after intubation	Prim. 0.32 ± 0.42 SD, Sec. 0.81 ± 0.33 SD	0.20 ± 0.19 SD	n.d.	0.002 in Sec. vs CPE	n.d.	n.d.	n.d.	n.d.	n.d.	n.d.
Schutte, 1996*	Prospective	12 vs 6	Protein in BAL	Within 72 h after intubation	671 ± 256 SEM	291 ± 81 SEM	ug/mL	n.d.	n.d.	n.d.	n.d.	n.d.	n.d.	n.d.
			PMN in BAL		16.1 ± 5.8 SEM	0.4 ± 0.11 × 10^6	/mL	n.d.	n.d.	n.d.	n.d.	n.d.	n.d.	n.d.
			Serum CRP*		235 ± 33 SEM	93 ± 25 SEM	mg/L	n.d.	n.d.	n.d.	n.d.	n.d.	n.d.	n.d.
Miller, 1996*	Prospective	27 vs 8	Protein in PEF/plasma	Within 30 min after intubation	0.90 ± 0.09 SEM in w/o sepsis, 0.84 ± 0.16 SEM in w sepsis,	0.48 ± 0.12 SEM	Ratio	<0.05	n.d.	n.d.	n.d.	n.d.	n.d.	n.d.
Others
Kushimoto, 2012***	Prospective	207 vs 26	EVWI	Not stated	18.5 ± 6.8 SD	14.4 ± 4.0 SD	mL/kg	<0.01	n.d.	n.d.	n.d.	n.d.	n.d.	n.d.
			PVPI		3.2 ± 1.4 SD	2.0 ± 0.8 SD	n.d.	<0.01	0.886	0.836-0.953	2.6–2.85	ALI/ARDS	0.9	0.95

ALI acute lung injury, ARDS acute respiratory distress syndrome, AUC area under the curve, BAL bronchoalveolar lavage, CPE cardiogenic pulmonary edema, CCP Clara cell protein, CRP C-reactive protein, ELF epithelial lining fluid, EVWI extravascular lung water index, HTI56 human type I cell-specific apical membrane protein, KGF keratinocyte growth factor, n.d. not described, n.s. not significant, PEF pulmonary edema fluid, PMN polymorphonuclear neutrophils, PVPI pulmonary vascular permeability index, s-Cath suction catheter, SD standard deviation, SEM standard error of the mean, SP-A surfactant Protein-A, SP-B surfactant protein-B
***Good, or *poor quality assessed based on biases using the modified Hayden’s criteria

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