Intensive Care Medicine

, Volume 32, Issue 1, pp 110–115

Alveolar plasminogen activator inhibitor-1 predicts ARDS in aspiration pneumonitis

  • Ali A. El Solh
  • Milapchand Bhora
  • Lilibeth Pineda
  • Alan Aquilina
  • Laurie Abbetessa
  • Eileen Berbary
Original

DOI: 10.1007/s00134-005-2847-2

Cite this article as:
El Solh, A.A., Bhora, M., Pineda, L. et al. Intensive Care Med (2006) 32: 110. doi:10.1007/s00134-005-2847-2

Abstract

Objective

To test the hypothesis that alveolar plasminogen activator inhibitor-1 (PAI-1) can identify patients with witnessed aspiration at risk for progression to acute respiratory distress syndrome (ARDS).

Design

Prospective observational study.

Setting

Medical intensive care unit in a tertiary care center.

Patients

Fifty-one patients with witnessed aspiration who had a PaO2/FIO2<300 for a period no less than 4 h from admission.

Interventions

Alveolar fluid sampling was performed within 8 h of intubation via luminal suction of the distal airways using a 13-Fr catheter. Plasma levels were collected simultaneously by venipuncture.

Measurements and results

Alveolar PAI-1 antigen levels were more than five times higher in those who progressed to ARDS than in those with uncomplicated aspiration pneumonitis (2687±1498 ng/ml vs. 587±535 ng/ml, respectively; p<0.001), while plasma levels of PAI-1 antigen were not significantly different between the two groups. The measured activity of PAI-1 antigen paralleled the levels observed in both media. A cut-off level of alveolar PAI-1 >1518 ng/ml was found to be 82.4% (56.6%–96.0%) sensitive and 97.1% (84.6%–99.5%) specific in predicting progression to ARDS. There was also a significant inverse relationship between elevation of PAI-1 antigen levels and the degree of lung injury as assessed by the days of unassisted ventilation (r2=0.37; p<0.001).

Conclusions

Elevation of alveolar PAI-1 antigen levels postaspiration is the consequence of local rather than systemic activation of the fibrinolytic system. Measurement of alveolar PAI-1 antigen levels can be a useful clinical marker in predicting progression to ARDS after gastric aspiration.

Keywords

Aspiration ARDS Plasminogen activator inhibitor-1 Outcome 

Supplementary material

supp.pdf (25 kb)
(PDF 25 KB)

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Ali A. El Solh
    • 1
    • 2
  • Milapchand Bhora
    • 2
  • Lilibeth Pineda
    • 2
  • Alan Aquilina
    • 2
  • Laurie Abbetessa
    • 2
  • Eileen Berbary
    • 2
  1. 1.Division of Pulmonary, Critical Care, and Sleep MedicineErie County Medical CenterBuffaloUSA
  2. 2.Department of Medicine, Division of Pulmonary, Critical Care, and Sleep MedicineUniversity at Buffalo School of Medicine and Biomedical SciencesBuffaloUSA

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