Am. J. Respir. Crit. Care Med., Volume 159, Number 5, May 1999, 1506-1509

Initial Serum Ferritin Levels in Patients with Multiple Trauma and the Subsequent Development of Acute Respiratory Distress Syndrome

ROSE A. SHARKEY, SEAMAS C. DONNELLY, KEVIN G. CONNELLY, COLIN E. ROBERTSON, CHRISTOPHER HASLETT, and JOHN E. REPINE

Respiratory Medicine Unit, Rayne Laboratory, University of Edinburgh, and the Accident & Emergency Department, Royal Infirmary Hospital, Edinburgh, Scotland; Webb-Waring Institute for Cancer, Aging, and Antioxidant Research and the Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Health Sciences, Denver Colorado

Acute respiratory distress syndrome (ARDS) represents a catastrophic form of inflammatory lung injury that occurs unpredictably in some, but not all, at-risk patients. In this study, we investigated serum ferritin as a marker for ARDS development in a homogenous group of patients at-risk because of multiple trauma. We hypothesized that since ferritin synthesis is increased by proinflammatory cytokines, which are increased and implicated in ARDS, that ferritin levels would increase and that ferritin increases would correlate with the degree of inflammation and therefore the development of ARDS. We studied 42 patients (25 male, 17 female) who as a consequence of multiple trauma became at-risk for developing ARDS. Using the European/American Consensus definition for ARDS, 16 (38%) patients subsequently developed ARDS (11 male and five female). We found that initial serum ferritin levels correlated with the subsequent development of both ARDS (progression to ARDS, median = 638 ng/ml; (range, 70 to 4,500) versus nonprogression to ARDS = 185 ng/ml; range, 12 to 2,850) (p = 0.02, r = 0.27) and multiple organ failure (p < 0.05, r = 0.39). Using our previously established cutoff points for serum ferritin, the positive predictive value was 62% for men and 75% for women. Initial serum ferritin levels also correlated with a measurement of the degree of initial trauma injury, i.e., the injury severity score (ISS) (p < 0.05, r = 0.37). However, there was no correlation between serum ferritin levels and other markers of clinical injury, namely, lowest Pa_O2/FI_O2 ratio (p = 0.67), days requiring ventilation (p = 0.09), or mortality (p = 0.42). A significant association existed between serum ferritin levels and products of endothelial activation, i.e., sE-selectin (p < 0.04, r = 0.37) and sICAM-1 (p < 0.01, r = 0.21). In the future, with the development of novel anti-inflammatory therapies, early identification of specific high-risk patients would allow the institution of these therapies and thereby increase the chances of reducing ARDS morbidity and mortality.

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