Dynamic Changes And Clinical Value Of Serum Ang-2 And SP-D In Pediatric Acute Respiratory Distress Syndrome

BackgroundPediatric Acute Respiratory Distress Syndrome(PARDS)is a common cause of death in critically ill children.The diagnosis of PARDS mainly relies on clinical criteria,which has some limitations and lacks biomarkers for early severity and prognosis.At present,there are few reports on the dynamic changes of lung capillary endothelial cell and alveolar epithelial cell injury biomarkers of PARDS.ObjectiveTo study the dynamic changes of Ang-2 and SP-D in pediatric Acute Respiratory Distress Syndrome(PARDS)with different severity and prognosis,and to explore their relationship with the severity and prognosis of ARDS,so as to provide help for early diagnosis and prediction of clinical outcome.Methods80 children with ARDS treated in PICU of our hospital from June 2018 to may2021 were collected.According to the oxygenation of children,they were divided into three subgroups: mild group(23 cases),moderate group(32 cases)and severe group(25 cases).According to the prognosis at discharge,they were divided into survival group(67 cases)and death group(13 cases).19 healthy children of corresponding age were collected as normal control group.Ang-2 and SP-D were determined by Enzyme-Linked Immunosorbent Assay(ELISA)after all samples were collected.The differences of Ang-2 and SP-D levels on the first day after the diagnosis of ARDS in children with different severity were compared,the changes of Ang-2 and SP-D levels on the first,third and eighth days after the diagnosis of ARDS in survival group and death group were compared,and the receiver operating characteristic curve(ROC curve)of Ang-2 and SP-D on the prognosis of ARDS on the first,third and eighth days was drawn.Results1.There were significant differences in Ang-2(H =46.082,P <0.001)and SP-D(H =13.221,P<0.001)in children with ARDS of different severity on day 1,and the levels of Ang-2 and SP-D increased gradually with the increase of disease severity.2.There were significant differences in Ang-2 of day 1(U=167,P<0.001),SP-D of day1(U=271,P=0.032),Ang-2 of day 3(U=16.5,P<0.001),SP-D of day3(U=6,P<0.001),Ang-2 of day 8(U=10,P<0.001)and SP-D of day8(U=6,P<0.001)in the survival group and the death group.The levels of the death group were significantly higher than those in the survival group.3.The predictive efficacy of Ang-2 and SP-D levels on the prognosis of ARDS at different time points: the AUC of Ang-2 on the first day was 0.808,the best cut-off value was 6000pg/ml,the sensitivity was 84.6%,the specificity was 76.1%,the positive predictive value was3.54,and the negative predictive value was 0.2;the AUC of Ang-2 on the third day was 0.981,the best cut-off value was 6971pg/ml,the sensitivity was 92.3%,and the specificity was 97.0%,the positive predictive value was 30.76 and the negative predictive value was 0.08;the AUC of Ang-2 on the 8th day was 0.989,the best cut-off value was 4171pg/ml,the sensitivity was 92.3%,and the specificity was98.5%.the AUC of SP-D on the first day was 0.689,the best cut-off value was13544pg/ml,the sensitivity was 84.6%,the specificity was 46.3%,the positive predictive value was 61.5,the negative predictive value was 0.07,the positive predictive value was 1.57,and the negative predictive value was 0.33;the AUC of SP-D on the third day was 0.993,the best cut-off value was 16003pg/ml,the sensitivity was 100%,and the specificity was 98.5%,the positive predictive value was 66.6 and the negative predictive value was 0;the AUC of SP-D on the 8th day was 0.983,the best cut-off value was 12294pg/ml,the sensitivity was 100.0%,the specificity was 97.0%,the positive predictive value was 33.3 and the negative predictive value was 0.4.There was significant difference in serum Ang-2(U=28.000,P<0.001)and SP-D(U=124.5,P<0.001)between ARDS case group and normal control group.The levels of Ang-2 and SP-D in ARDS case group were significantly increased.ConclusionSerum Ang-2 and SP-D levels increased with the progression of PARDS,and the dynamic changes of Ang-2 and SP-D in PARDS with different prognosis were different during the course of disease.For early warning of clinical outcome of PARDS,a combined Ang-2 and SP-D test can be performed on day 3 of the course of disease.