The Clinical Guiding Significance Of Plasma Keratin-14 Levels In Patients With Acute Respiratory Distress Syndrome

Objective: To investigate the clinical signification of plasma keratin-14 levels in patients with acute respiratory distress syndrome(ARDS).Methods: A prospective observation was conducted. Fifty-two ARDS patients were enrolled while twenty non-ARDS patients were served as control. The acute physiology and chronic health evaluation II(APACHE II)score, oxygenation index(Pa O2/Fi O2) were recorded, and the plasma levels of keratin-14(KRT-14), tumor necrosis factor- α(TNF-α), interleukin-6(IL-6), procalcitonin(PCT), C-reactive protein(CRP) were measured within 24 hours after admission. There were 18 patients randomly selected from the ARDS group who were measured plasma KRT-14 levels again at the 7th day of hospitalization. The independent risk factors of ARDS were analyzed by univariate and multivariable logistic regression. Receiver operating characteristic curve(ROC) was plotted to evaluate the value of KRT-14 in predicting ARDS patients. T-test was used for explaining the different plasma KRT-14 levels between the deaths and the survivors after them admitting to the hospital. This analysis also used to compare the KRT-14 levels between the healthy control group and the ARDS patients group. It also explained the difference between the pneumonia group andthe pneumonia induced ARDS group.Results : Compared with non-ARDS group, APACHE II score and mortality were increased while Pa O2/Fi O2 was decreased. And levels of the plasma biomarkers we measured were all elevated. KRT, IL-6 and CRP were increased with the aggravation of the disease. The plasma KRT-14 levels was significantly negatively correlated with Pa O2/Fi O2(r=-0.548,P=0.00). Increased plasma KRT-14 levels within 24 hours(OR=0.007, 95%CI=0.000~0.319, P=0.011) after admission were the independent prognostic factors for the 28-day mortality in ARDS, and KRT-14 levels of the death was obviously higher than that of the survivors.The area under the ROC curve of KRT-14 was 0.97, the optimal critical value of KRT-14 was 3.52μg/L, the specificity was 90%, and sensitivity was 96.2%. Compared with the healthy people and the common pneumonic human, the ARDS patients had higher plasma KRT-14 levels.Conclusions : The increasing plasma KRT-14 levels was a significantly indicated some degree of lung injury. It can be a clinical auxiliary index because of it’s important prognosis evaluation and correlation with the degree of ARDS patients.