Evolution of leukotriene B-4, peptide leukotrienes, and interleukin-8 plasma concentrations in patients at risk of acute respiratory distress syndrome and with acute respiratory distress syndrome: Mortality prognostic study

Objective: To compare the evolution of plasma concentrations of leukotriene (LT) B-4, LTC4, LTD4, and interleukin (IL)-8 in patients with acute respir atory distress syndrome (ARDS) and in patients at risk of ARDS and to asses s the value of these mediators in predicting mortality rate from ARDS, Design: A case-control study comparing ARDS patients and patients at risk o f ARDS as well as survivors and nonsurvivors with ARDS, Setting: Hospital intensive care unit, laboratory, and department of hemato logy, Patients Twenty-one patients with ADDS and 14 patients at risk of ARDS, Intervention: Arterial blood samples were collected on days 0, 1, and 5 aft er admission to the intensive care unit. Measurements and Main Results: LTs were extracted, separated by high-pressu re liquid chromatography and quantified by enzyme immunoassay, IL-8 was ana lyzed by ELISA, Plasma concentrations of LTB4 and LTC4 plus LTD4 were signi ficantly higher in ARDS patients than in patients at risk of ARDS during th e first 24 hrs, Concentrations of IL-8 were also higher in ARDS patients th an in patients at risk throughout the study, although the differences betwe en the two groups were only significant on day 5. Only the plasma concentra tion of LTB4 on day 1 was a marker of ADDS (72,2% sensitivity, 84.6% specif icity). A logistic regression analysis showed that LTB4 and IL-8, on day 1, were markers of mortality rate in patients with ARDS (70.0% sensitivity, 8 7.5% specificity), Conclusions: LTs are elevated during the early phases of ARDS, whereas IL-8 increases throughout the study, The evaluation of LTB4 and IL-8 may be use ful prognostic indices in patients with early phase ADDS after admission to the intensive care unit.