• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of thoraxThoraxInstructions for authorsInstructions for authors
Thorax. Nov 2003; 58(11): 983–988.
PMCID: PMC1746524

Plasma surfactant protein levels and clinical outcomes in patients with acute lung injury


Methods: Data from 565 participants in the clinical trial were used. Plasma levels of SP-A and SP-D were measured at baseline and on day 3 after the start of the mechanical ventilation protocol. The longitudinal impact of baseline plasma surfactant protein levels on clinical outcomes was examined by multivariate analysis, controlling for mechanical ventilation group, APACHE III score, and other clinical covariates. The effect of 6 ml/kg tidal volume ventilation on plasma SP-A and SP-D levels was evaluated using analysis of covariance.

Results: Baseline plasma SP-A levels were not related to any clinical outcome. In contrast, higher baseline plasma SP-D levels were associated with a greater risk of death (OR 1.21 per 100 ng/ml increment; 95% CI 1.08 to 1.35), fewer ventilator-free days (mean decrease -0.88 days; p=0.001), and fewer organ failure-free days (mean decrease -1.06 days; p<0.0001). The 6 ml/kg tidal volume strategy had no effect on the rise in plasma SP-A levels (p=0.91) but attenuated the rise in plasma SP-D levels (p=0.0006).

Conclusions: Early in the course of ALI/ARDS an increased level of plasma SP-D is associated with a worse clinical outcome. The 6 ml/kg tidal volume strategy attenuated the rise of SP-D early in the clinical course. Taken together, these observations indicate that plasma SP-D, a product of alveolar type II cells, is a valuable biomarker in ALI/ARDS.

Full Text

The Full Text of this article is available as a PDF (252K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Hudson LD, Steinberg KP. Epidemiology of acute lung injury and ARDS. Chest. 1999 Jul;116(1 Suppl):74S–82S. [PubMed]
  • Monchi M, Bellenfant F, Cariou A, Joly LM, Thebert D, Laurent I, Dhainaut JF, Brunet F. Early predictive factors of survival in the acute respiratory distress syndrome. A multivariate analysis. Am J Respir Crit Care Med. 1998 Oct;158(4):1076–1081. [PubMed]
  • Zilberberg MD, Epstein SK. Acute lung injury in the medical ICU: comorbid conditions, age, etiology, and hospital outcome. Am J Respir Crit Care Med. 1998 Apr;157(4 Pt 1):1159–1164. [PubMed]
  • Greene KE, Wright JR, Steinberg KP, Ruzinski JT, Caldwell E, Wong WB, Hull W, Whitsett JA, Akino T, Kuroki Y, et al. Serial changes in surfactant-associated proteins in lung and serum before and after onset of ARDS. Am J Respir Crit Care Med. 1999 Dec;160(6):1843–1850. [PubMed]
  • Doyle IR, Nicholas TE, Bersten AD. Serum surfactant protein-A levels in patients with acute cardiogenic pulmonary edema and adult respiratory distress syndrome. Am J Respir Crit Care Med. 1995 Jul;152(1):307–317. [PubMed]
  • Doyle IR, Bersten AD, Nicholas TE. Surfactant proteins-A and -B are elevated in plasma of patients with acute respiratory failure. Am J Respir Crit Care Med. 1997 Oct;156(4 Pt 1):1217–1229. [PubMed]
  • Frank James A, Gutierrez Jorge A, Jones Kirk D, Allen Lennell, Dobbs Leland, Matthay Michael A. Low tidal volume reduces epithelial and endothelial injury in acid-injured rat lungs. Am J Respir Crit Care Med. 2002 Jan 15;165(2):242–249. [PubMed]
  • Eisner Mark D, Thompson B Taylor, Schoenfeld David, Anzueto Antonio, Matthay Michael A. Airway pressures and early barotrauma in patients with acute lung injury and acute respiratory distress syndrome. Am J Respir Crit Care Med. 2002 Apr 1;165(7):978–982. [PubMed]
  • Eisner MD, Thompson T, Hudson LD, Luce JM, Hayden D, Schoenfeld D, Matthay MA. Efficacy of low tidal volume ventilation in patients with different clinical risk factors for acute lung injury and the acute respiratory distress syndrome. Am J Respir Crit Care Med. 2001 Jul 15;164(2):231–236. [PubMed]
  • Greene KE, Ye S, Mason RJ, Parsons PE. Serum surfactant protein-A levels predict development of ARDS in at-risk patients. Chest. 1999 Jul;116(1 Suppl):90S–91S. [PubMed]
  • Inoue T, Matsuura E, Nagata A, Ogasawara Y, Hattori A, Kuroki Y, Fujimoto S, Akino T. Enzyme-linked immunosorbent assay for human pulmonary surfactant protein D. J Immunol Methods. 1994 Aug 1;173(2):157–164. [PubMed]
  • Knaus WA, Wagner DP, Draper EA, Zimmerman JE, Bergner M, Bastos PG, Sirio CA, Murphy DJ, Lotring T, Damiano A, et al. The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest. 1991 Dec;100(6):1619–1636. [PubMed]
  • Bernard GR, Wheeler AP, Arons MM, Morris PE, Paz HL, Russell JA, Wright PE. A trial of antioxidants N-acetylcysteine and procysteine in ARDS. The Antioxidant in ARDS Study Group. Chest. 1997 Jul;112(1):164–172. [PubMed]
  • Greenland S. Basic problems in interaction assessment. Environ Health Perspect. 1993 Dec;101 (Suppl 4):59–66. [PMC free article] [PubMed]
  • Ranieri VM, Suter PM, Tortorella C, De Tullio R, Dayer JM, Brienza A, Bruno F, Slutsky AS. Effect of mechanical ventilation on inflammatory mediators in patients with acute respiratory distress syndrome: a randomized controlled trial. JAMA. 1999 Jul 7;282(1):54–61. [PubMed]
  • Doyle RL, Szaflarski N, Modin GW, Wiener-Kronish JP, Matthay MA. Identification of patients with acute lung injury. Predictors of mortality. Am J Respir Crit Care Med. 1995 Dec;152(6 Pt 1):1818–1824. [PubMed]
  • Gattinoni L, Pelosi P, Suter PM, Pedoto A, Vercesi P, Lissoni A. Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease. Different syndromes? Am J Respir Crit Care Med. 1998 Jul;158(1):3–11. [PubMed]
  • Hudson LD, Milberg JA, Anardi D, Maunder RJ. Clinical risks for development of the acute respiratory distress syndrome. Am J Respir Crit Care Med. 1995 Feb;151(2 Pt 1):293–301. [PubMed]
  • Roupie E, Lepage E, Wysocki M, Fagon JY, Chastre J, Dreyfuss D, Mentec H, Carlet J, Brun-Buisson C, Lemaire F, et al. Prevalence, etiologies and outcome of the acute respiratory distress syndrome among hypoxemic ventilated patients. SRLF Collaborative Group on Mechanical Ventilation. Société de Réanimation de Langue Française. Intensive Care Med. 1999 Sep;25(9):920–929. [PubMed]
  • Sloane PJ, Gee MH, Gottlieb JE, Albertine KH, Peters SP, Burns JR, Machiedo G, Fish JE. A multicenter registry of patients with acute respiratory distress syndrome. Physiology and outcome. Am Rev Respir Dis. 1992 Aug;146(2):419–426. [PubMed]
  • Suchyta MR, Clemmer TP, Elliott CG, Orme JF, Jr, Weaver LK. The adult respiratory distress syndrome. A report of survival and modifying factors. Chest. 1992 Apr;101(4):1074–1079. [PubMed]
  • Valta P, Uusaro A, Nunes S, Ruokonen E, Takala J. Acute respiratory distress syndrome: frequency, clinical course, and costs of care. Crit Care Med. 1999 Nov;27(11):2367–2374. [PubMed]
  • Willms D, Nield M, Gocka I. Adult respiratory distress syndrome: outcome in a community hospital. Am J Crit Care. 1994 Sep;3(5):337–341. [PubMed]

Articles from Thorax are provided here courtesy of BMJ Group


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • PubMed
    PubMed citations for these articles
  • Substance
    PubChem Substance links

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...