Am. J. Respir. Crit. Care Med., Vol 151, No. 1, Jan 1995, 15-20.
von Willebrand factor antigen levels are not predictive for the adult respiratory distress syndrome
M Moss, L Ackerson, MK Gillespie, FA Moore, EE Moore and PE Parsons
Department of Medicine, National Jewish Center for Immunology and Respiratory Medicine, Denver, Colorado.
In patients with nonpulmonary sepsis, von Willebrand factor antigen (vWF:Ag
or Factor VIIR:Ag) levels have been reported to be predictive for the
development of the adult respiratory distress syndrome (ARDS). We addressed
the ability to generalize these results by measuring serial Factor vWF:Ag
levels in 96 patients at risk for the development of ARDS. Patients with
sepsis, pancreatitis, hypertransfusion, witnessed aspiration of gastric
contents, abdominal trauma, chest trauma, and multiple fractures were
studied. Sequential measurements were obtained at enrollment into the study
(T = 0), and T = 6, 12, 24, and 48 h. Subjects were grouped into sepsis and
nonsepsis categories and analyzed according to the following outcome
definitions: ARDS and non-ARDS. The mean values for the sepsis and
nonsepsis groups were elevated above normal at all time points. A
statistically significant difference occurred in the mean vWF:Ag level for
the ARDS and non-ARDS patients in the nonsepsis group at T = 0 (p = 0.05).
To assess the clinical utility of these results, ROC (receiver operating
characteristics) curves were plotted at T = 0, and optimal cutoff values of
vWF:Ag were determined. In the sepsis group, the best value for vWF:Ag
above which patients would actually develop ARDS was 399%, resulting in a
70% sensitivity and a 47% specificity. For the non- sepsis patients, the
optimal value was 273%, yielding a sensitivity of 64% and a specificity of
52%. We conclude that measuring vWF:Ag levels are not helpful in predicting
the progression to ARDS in multiple at- risk patients.
