PREDICTION OF POSTTRAUMATIC ADULT-RESPIRATORY-DISTRESS-SYNDROME BY ALBUMIN EXCRETION RATE 8 HOURS AFTER ADMISSION

Background: Adult respiratory distress syndrome (ARDS) in trauma victi ms carries a mortality on the order of 50%. An early feature is an inc reased capillary permeability causing an extravasation of plasma prote ins and water, leading to interstitial edema. In the kidney, the incre ase in microvascular permeability is manifested as increased albumin e xcretion detectable by sensitive immunoassay. Methods: Forty seven tra uma victims were studied for 5 days; 32 of them had Injury Severity Sc ores > 18. A diagnosis of ARDS was made on the recommendations of the American-European Consensus Conference on ARDS (1994). Eight patients developed ARDS, five developed pulmonary dysfunction, and the remainde r showed no significant pulmonary abnormality. Results: Using the near patient urine albumin immunoassay, albumin excretion rate (AER) was m easured after admission. For patients with Injury Severity Score > 18, the median (95% confidence interval) AER 8 hours after admission was 63 (range, 40-99) mu g per minute for those without impaired lung func tion and 339 (range, 162-354) mu g per minute for those in the combine d ARDS and pulmonary dysfunction group (Mann-Whitney test, p = 0.0004) . The median AER was 51 (range, 27-98) mu g per minute for patients wi th Injury Severity Score < 18. The positive predictive value for the d evelopment of ARDS or pulmonary dysfunction of AER > 130 E mu g per mi nute was 85%, with a negative predictive value of 95%. Conclusions: Th ese data indicate that the capillary leak associated with the subseque nt development of pulmonary dysfunction and ARDS can be detected withi n 8 hours of admission at the patient's bedside, thus providing a mean s of early identification of patients at greatest risk and allowing fo r early intervention.