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Title: Plasma sRAGE is independently associated with increased mortality in ARDS: a meta-analysis of individual patient data
Authors: Matthieu Jabaudon
Raiko Blondonnet
Bruno Pereira
Rodrigo Cartin-Ceba
Christoph Lichtenstern
Tommaso Mauri
Rogier M. Determann
Tomas Drabek
Rolf D. Hubmayr
Ognjen Gajic
Florian Uhle
Andrea Coppadoro
Antonio Pesenti
Marcus J. Schultz
Marco V. Ranieri
Helena Brodska
Ségolène Mrozek
Vincent Sapin
Michael A. Matthay
Jean Michel Constantin
Carolyn S. Calfee
V eobecná Fakultní Nemocnice V Praze
Università degli Studi di Milano
CHU de Toulouse
University of California, San Francisco
Our Lady Hospital - Amsterdam
Azienda Ospedaliera San Gerardo Monza
Mahidol University
Università degli Studi di Torino
Centre Hospitalier Universitaire de Clermont-Ferrand
Mayo Clinic
Universite d' Auvergne Clermont-FD 1
Universitätsklinikum Heidelberg
University of Pittsburgh School of Medicine
Amsterdam UMC - University of Amsterdam
Keywords: Medicine
Issue Date: 1-Sep-2018
Citation: Intensive Care Medicine. Vol.44, No.9 (2018), 1388-1399
Abstract: © 2018, The Author(s). Purpose: The soluble receptor for advanced glycation end-products (sRAGE) is a marker of lung epithelial injury and alveolar fluid clearance (AFC), with promising values for assessing prognosis and lung injury severity in acute respiratory distress syndrome (ARDS). Because AFC is impaired in most patients with ARDS and is associated with higher mortality, we hypothesized that baseline plasma sRAGE would predict mortality, independently of two key mediators of ventilator-induced lung injury. Methods: We conducted a meta-analysis of individual data from 746 patients enrolled in eight prospective randomized and observational studies in which plasma sRAGE was measured in ARDS articles published through March 2016. The primary outcome was 90-day mortality. Using multivariate and mediation analyses, we tested the association between baseline plasma sRAGE and mortality, independently of driving pressure and tidal volume. Results: Higher baseline plasma sRAGE [odds ratio (OR) for each one-log increment, 1.18; 95% confidence interval (CI) 1.01–1.38; P = 0.04], driving pressure (OR for each one-point increment, 1.04; 95% CI 1.02–1.07; P = 0.002), and tidal volume (OR for each one-log increment, 1.98; 95% CI 1.07–3.64; P = 0.03) were independently associated with higher 90-day mortality in multivariate analysis. Baseline plasma sRAGE mediated a small fraction of the effect of higher ΔP on mortality but not that of higher VT. Conclusions: Higher baseline plasma sRAGE was associated with higher 90-day mortality in patients with ARDS, independently of driving pressure and tidal volume, thus reinforcing the likely contribution of alveolar epithelial injury as an important prognostic factor in ARDS. Registration: PROSPERO (ID: CRD42018100241).
ISSN: 14321238
Appears in Collections:Scopus 2018

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