High plasma levels linked to severe ARDS in children with respiratory failure

Elevated surfactant protein D levels are associated with severe acute respiratory distress syndrome and poor outcomes in children with acute respiratory failure, according to results published in Chest.

“Elevated surfactant protein D in serum or plasma is associated with both acute and chronic lung injury in adults and is considered to be a relatively specific indicator of injury in the lung,” Mary K. Dahmer, PhD, associate professor of pediatrics in the division of pediatric critical care medicine in the department of pediatrics and associate fellowship director for research at the University of Michigan, Ann Arbor, and colleagues wrote. “Adult studies have shown that surfactant protein D is associated with ARDS and with poor outcome in patients with ARDS. In pediatrics, elevated serum surfactant protein D has been reported to be associated with respiratory distress syndrome in neonates.”

Researchers conducted a prospective cohort study on 350 children aged 2 weeks to 17 years with acute respiratory failure who participated in the BALI multicenter study. Surfactant protein D levels in plasma, measured by enzyme-linked immunosorbent assay, were obtained the day of intubation or the following 2 days.

Of 350 children, 233 (median age, 4.6 years; 45% girls) had pediatrics ARDS with surfactant protein D varying across primary diagnoses (P < .001). In children with elevated surfactant protein D levels, researchers observed an association with severe pediatric ARDS (OR = 1.02; 95% CI, 1.01-1.04; P = .011) and a correlation with the age of the children (P = .002).

Elevated surfactant protein D levels were also associated with death (OR = 1.02; 95% CI, 1.01-1.04; P = .004), mechanical ventilation duration (P = .012), pediatric ICU length of stay (P = .019) and highest oxygenation index (P = .04) in multivariable analyses.

“Future studies should test whether levels of plasma surfactant protein D can be used as a more sensitive indicator of lung injury or response to treatment than the currently available clinical measures and whether it is useful in identifying endotypes in children with pediatric ARDS,” the researchers wrote.