Keratinocyte growth factor and hepatocyte growth factor in bronchoalveolarlavage fluid in acute respiratory distress syndrome patients

Objectives: To determine bronchoalveolar lavage (BAL) fluid concentrations of keratinocyte growth factor (KGF) and hepatocyte growth factor (HGF), two potent growth factors for alveolar type II epithelial cells, in patients w ith acute respiratory distress syndrome (ARDS). Design: Prospective study. Setting: An adult trauma/surgical intensive care unit in an urban teaching hospital. Patients: A total of 32 ventilated patients with pulmonary infiltrates pros pectively identified with ARDS (n = 17) or without ARDS (n = 15), including eight patients with hydrostatic edema (HE), and ten nonventilated patients serving as controls. Interventions: None. Measurements and Main Results: BAL was performed 2.88 days +/- 2.4, 3.5 day s +/- 2.4, and 2.3 days +/- 2.2 after the lung insult in ARDS, HE, and othe r non-ARDS patients respectively (p = .32). KGF was detected in BAL fluid i n 13 of the 17 ARDS patients (median, 31.6 pg/mL), in one patient with HE, and in none of other non-ARDS patients. In ARDS patients, detection of KGF in BAL was associated in BAL fluid with the detection of type III procollag en peptide (PIIIP), a biological marker of fibroproliferation. In ARDS pati ents, detection of KGF in BAL was associated with death (p = .02). HGF was detected in 15 ARDS patients (median, 855 pg/mL), in seven patients with HE (median, 294 pg/mL; p = .05 for the comparison with ARDS group), in six of other non-ARDS patients (median, 849 pg/mL; p = .32 with ARDS group). HGF concentrations were higher in nonsurvivors than in survivors (p = .01). Non e of the ten BAL of controls contained either KGF or HGF. Conclusion: KGF was detected almost exclusively in BAL fluid from ARDS pati ents and correlated with a poor prognosis in this group. In contrast, HGF w as detected in the BAL fluid from a majority of patients with or without AR DS. Elevated HGF concentrations were associated with a poor prognosis in th e overall group.