The correlation between endothelin-1 levels and spirometry in dialysis patients compared to healthy subjects.

BACKGROUND AND AIM: Several studies demonstrated a six-fold increase in plasma concentration of endothelin-1 (ET-1) in diaysis patients (hemodialysis and peritoneal dialysis) compared to healthy control subjects. However, the effects of ET-1 on respiratory function in these patients are less known. The aim of this study was to determine the potential differences in spirometric values in relation to ET-1 levels. METHODS: The study included 28 patients (15 male, 13 female, mean age 55.9 +/- 16. 2 years) with end stage renal diseases (ESRD) receiving regular hemodialysis (HD), 23 patients (10 males, 13 females, mean age 55.8 +/- 15.8 years) with ESRD treated with continuous ambulatory peritoneal dialysis (CAPD) without any cardiovascular or respiratory diseases, and 30 healthy volunteers (14 male, 16 female, mean age 51.8 +/- 15.6 years) in control group. In each of the three groups the participants were divided into two additional sub-groups according to the serum levels of ET-1. The spirometry values were recorded before the onset of hemodialysis and prior to emptying the peritoneal cavity in CAPD patients. The results were analyzed using standard statistical methods (Student's t-test). RESULTS: Patients who were treated with HD or CAPD were found to have significant difference in values of most pulmonary function parameters between subjects with ET-1 levels lower than 6.6 pg/ml and subjects with ET-1 levels higher than 6.6 pg/ml. In the control group there was no difference in pulmonary function parameters in correlation with ET-1 levels. ET-1 values in patients of both dialysis groups were significantly higher compared to healthy subjects. CONCLUSIONS: Higher levels of ET-1 in dialysis patients over healthy subjects is associated with lower parameters of lung function tests. A possible pathophysiological mechanism for deterioration of pulmonary function might be explained by progression of inflammation, pulmonary oedema also known as "uraemic lung" or/and the progression of pulmonary hypertension.

Acute lung injury prediction score: derivation and validation in a population-based sample.

Early recognition of patients at high risk of acute lung injury (ALI) is critical for successful enrollment of patients in prevention strategies for this devastating syndrome. We aimed to develop and prospectively validate an ALI prediction score in a population-based sample of patients at risk. In a retrospective derivation cohort, predisposing conditions for ALI were identified at the time of hospital admission. The score was calculated based on the results of logistic regression analysis. Prospective validation was performed in an independent cohort of patients at risk identified at the time of hospital admission. In a derivation cohort of 409 patients with ALI risk factors, the lung injury prediction score discriminated patients who developed ALI from those who did not with an area under the curve (AUC) of 0.84 (95% CI 0.80-0.89; Hosmer-Lemeshow p = 0.60). The performance was similar in a prospective validation cohort of 463 patients at risk of ALI (AUC 0.84, 95% CI 0.77-0.91; Hosmer-Lemeshow p = 0.88). ALI prediction scores identify patients at high risk for ALI before intensive care unit admission. If externally validated, this model will serve to define the population of patients at high risk for ALI in whom future mechanistic studies and ALI prevention trials will be conducted.

Early identification of patients with or at risk of acute lung injury.

Acute lung injury (ALI ) and its more severe form, acute respiratory distress syndrome (ARDS ), are important critical care syndromes for which the treatment options are limited once the condition is fully established. Enormous basic and clinical research efforts have led to improvements in supportive treatment, but surprisingly little has been done on the prevention of this devastating syndrome. The development and progression of ALI /ARDS may be triggered by various intrahospital exposures including but not limited to transfusion, aspiration, mechanical ventilation, certain medications and delayed treatment of shock and infection. Early recognition of patients with or at risk of ALI /ARDS is essential for designing novel prevention and treatment strategies. Automated electronic screening tools and novel scoring systems applied at the time of hospital admission may facilitate enrollment of patients into mechanistic and outcome studies, as well as future ALI /ARDS prevention trials.

Bronchodilatation test response predictors in lung function assessment of patients with resectable lung cancer and concomitant chronic obstructive pulmonary disease.

PURPOSE: The goal of this pilot study was to determine factors influencing the bronchodilatation test (BDT) response during preoperative lung function assessment in patients with resectable non-small cell lung cancer (NSCLC) and concomitant chronic obstructive pulmonary disease (COPD). PATIENTS AND METHODS: The analysis included 34 patients who met the following entry criteria: preoperative lung function assessment including a BDT, presence of operable, histologically confirmed stage IA-IIIA NSCLC established by computerized tomography (CT) and endoscopical findings, no more than one cardiovascular risk factor present, no interstitial pulmonary diseases (restriction exclusively due to the tumor), and patient's age up to 70 years. The study was partially retrospective and partially prospective. BDT was performed by forced expiratory volume in the first second (FEV1) measurement prior to and 30 min after two Berodual(R) inhalations (0.005 mg of fenoterol + 0.002 mg of ipratropium bromide per inhalation). RESULTS: Possible predictors of BDT response may include history of COPD longer than 15 years, N2 lymph nodes involvement, total lung restriction, and presence of a visible tumor in the main and intermediate bronchus. CONCLUSION: These possible predictors remain hypothetical as the study cohort is rather small, so a large scale research should follow to provide reliable data necessary to make definite conclusions.