Clinical Signification Of Serum GRP78 Levels In Patients With Acute Respiratory Distress Syndrome

ObjectiveAcute respiratory distress syndrome?ARDS?is a common critical illness in respiratory department,with a mortality rate of up to 45%and a severe social and economic burden.The pathophysiological process and mechanism of ARDS are not well understood,and there is still no clear and effective treatment method.It is of great significance to explore biological markers related to the occurrence and development of ARDS that can help to determine the prognosis of ARDS in early clinical prevention and treatment.Endoplasmic reticulum stress?ERS?is a series of stress responses that are triggered by disruption of endoplasmic reticulum homeostasis and maintain normal cell function,which induces inflammation and apoptosis.It is involved in the process of acute lung injury caused by infection,endotoxin,other organ injury and other factors.Glucose-regulated protein78?GRP78?is an important molecular chaperone in the endoplasmic reticulum,and is also considered as an ERS marker protein.Therefore,we speculate that if the serum GRP78 concentration is too high,ERS response will be too strong,leading to lots of apoptosis,which may be a poor prognostic factor for ARDS.To observe the serum GRP78 level of patients with acute respiratory distress syndrome?ARDS?,and its role and clinical significance in the development of acute respiratory distress syndrome?ARDS?..MethodA retrospective investigation was conducted.52 patients with ARDS were selected as the study subjects and divided into the non-survivor group and the survivor group according to the outcomes of the patients at 28 days.Collecting their basic clinical information,body mass index?BMI?,acutephysiology and chronic health evaluation system?(APACHE oxygenation Index?FiO₂/PO₂?,hospitalization length,invasive mechanicalventilation length,and blood examination results such as white blood cell counts?WBC?,procalcitonin?PCT?and c-reactive protein?CRP?,etc.At the same time,20 pneumonia patients and 20 healthy volunteers were involved as the control group,and 2ml of venous blood sample from each subject was collected for further study.Serum GRP78 levels were detected and compared among those groups.ResultThe serum GRP78 level of ARDS patients was significantly higher than that of normal pneumonia and healthy physical examination subjects?P<0.05?.Compared with the survival group,the serum GRP78 level in the death group was significantly increased?P<0.05?.The serum GRP78 level of ARDS patients was negatively correlated with FiO2/PO2?r=-0.50,P<0.05?,and positively correlated with APACHEII score?r=0.41,P<0.05?.The area under ROC curve of GRP78 was 0.737 in predicting the death outcome of ARDS.When GRP78 was?167.09pg/ml,its sensitivity and specificity were 42.86%and 93.55%respectively.ConclusionEndoplasmic reticulum stress is involved in the occurrence and development of ARDS.The serum GRP78 level has predictive value for the occurrence of ARDS and the prognosis of ARDS patients.