PLASMA ELASTASE LEVELS AND THE DEVELOPMENT OF THE ADULT-RESPIRATORY-DISTRESS-SYNDROME

Inflammatory cells, particularly neutrophil granulocytes, have been im plicated in the pathogenesis of the adult respiratory distress syndrom e (ARDS). In this study, we investigated whether a relationship exists between neutrophil elastase in the plasma of multiple-trauma patients on initial hospital presentation and the subsequent development of lu ng injury and ARDS. Sixty-one multiple-trauma patients were enrolled p rospectively. Neutrophil elastase was measured by a specific radioimmu noassay, and analysis was performed by nonparametric statistical metho ds. A highly significantly elevated plasma elastase level was found in patients who progressed to ARDS (median 217 ng/ml, range 127 to 480) (n = 8) compared with those who did not (median 117 ng/ml, range 21.4 to 685) (n = 53) (p = 0.009). Significant correlation was found betwee n initial elastase values and subsequent requirement for mechanical ve ntilation (p = 0.01), lowest arterial oxygen saturation/oxygen supplem entation recorded (p = 0.003), and organ failure score (p = 0.006). Th is study shows that within minutes of the initiating trauma event, the re is evidence of enhanced neutrophil degranulation as manifested by e levated levels of immunoreactive neutrophil elastase in the peripheral blood. The level of this enzyme correlates with the degree of subsequ ent lung injury and ARDS. These findings reinforce the importance of n eutrophils and their secretory products in early ARDS disease pathogen esis.