Clinical Utility of Pre-B-Cell Colony-Enhancing Factor in Bronchoalveolar Lavage Fluid of Acute Critical Ill Patients with Lung Infiltrates

Kwangha Lee; Sang-Bum Hong

doi:10.4046/trd.2009.67.5.402

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Lee and Hong: Clinical Utility of Pre-B-Cell Colony-Enhancing Factor in Bronchoalveolar Lavage Fluid of Acute Critical Ill Patients with Lung Infiltrates

Original Article

Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2009; 67(5): 402-408.

Published online: 30 November 2009

DOI: https://doi.org/10.4046/trd.2009.67.5.402

Clinical Utility of Pre-B-Cell Colony-Enhancing Factor in Bronchoalveolar Lavage Fluid of Acute Critical Ill Patients with Lung Infiltrates

Kwangha Lee, M.D., Sang-Bum Hong, M.D.

Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Address for correspondence: Sang-Bum Hong, M.D. Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1, Pungnap 2-dong, Songpa-gu, Seoul 138-736, Korea. Phone: 82-2-3010-3893, Fax: 82-2-3010-6968, sbhong@amc.seoul.kr

Received 12 October 2009 Accepted 14 October 2009

Abstract

Background

Pre-B-cell colony enhancing factor (PBEF) has been suggested as a novel biomarker in sepsis and acute lung injury. We measured the PBEF in bronchoalveolar lavage (BAL) fluid of acute critically ill patients with lung infiltrates in order to evaluate the clinical utility of measuring PBEF in BAL fluid.

Methods

BAL fluid was collected by bronchoscope from 185 adult patients with lung infiltrates. An enzyme-linked immunosorbent assay was then performed on the collected fluids to measure the PBEF.

Results

Mean patient age was 59.9±14.5 years and 63.8% of patients were males. The mean concentration of PBEF in BAL fluid was 17.5±88.3 ng/mL, and patients with more than 9 ng/mL of PBEF concentration (n=26, 14.1%) had higher Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores on the BAL exam day. However, there were no significant differences in clinical characteristics between survivors and non-survivors. In patients with leukocytosis (n=93) seen on the BAL exam day, the linear regression analysis revealed a significant, positive relationship between PBEF and APACHE II (r²=0.06), SOFA score (r²=0.08), Clinical Pulmonary Infection Score (r²=0.05), and plateau pressure in patients on ventilators (r²=0.07) (p<0.05, respectively). In addition, multivariate regression analysis with PBEF as a dependent variable showed that the plateau pressure (r²=0.177, p<0.05) was correlated positively with PBEF.

Conclusion

The PBEF level in the BAL fluid may be a useful, new biomarker for predicting the severity of illness and ventilator-induced lung injury in critically ill patients with lung infiltates and leukocytosis.

Keywords: Nicotinamide Phosphoribosyltransferase, Bronchoalveolar Lavage Fluid, Critical Illness, Lung Diseases

Figures and Tables

Figure 1

Distribution of PBEF concentration in bronchoalveolar lavage fluid.

Figure 2

Correlation between PBEF concentration and other clinical characteristics in patients with leukocytosis (total n=93). For statistic analyses, the PBEF levels in bronchoalveolar lavage (BAL) fluid were log-transformed in order to achieve a normal distribution. APACHE II: acute physiology and chronic health evaluation II; SOFA: sequential organ failure assessment; CPIS: clinical pulmonary infection score; PBEF: pre-B-cell colony enhancing factor; CI: confidential interval.

Table 1

Main underlying disease in patients with bilateral lung infiltrates

COPD: chronic obstructive pulmonary disease; TB: tuberculosis.

^*Other diseases uncontrolled diabetes (1), pregnant status (1), multiple trauma (1), pancreatic pseudocyst (1), AIDS (1), ulcerative colitis (1), hypothyroidism (1).

Table 2

Clinical diagnosis on initial ICU admission

ICU: intensive care unit; ALI: acute lung injury.

^*Other diseases includes pulmonary edema (3), influenza pneumonia (2), radiation pneumonitis (1), hypersensitivity pneumonitis (1), and legionella pneumonia (1).

Table 3

Clinical characteristics in patients, depending on the level of PBEF

Data are expressed as means±SD (continuous values) or number (%) (categorical values). Statistical significance was tested according to the analysis of variance among the patient groups.

MV: mechanical ventilation; ICU: intensive care unit; APACHE II: acute physiology and chronic health evaluation II; SOFA: sequential organ failure assessment; BAL: bronchoalveolar lavage; CPIS: clinical pulmonary infection score; WBC: white blood cell.

^*The same letter indicates significant difference between both groups based on Tukey's multiple comparison tests.

Table 4

The clinical characteristics of patients with leukocyte count <10,000×10³/mm³ and leukocyte count ≥10,000×10³/mm³

Data are expressed as means±SD (continuous values) or number (%) (categorical values).

Notes

This study was supported by a grant from The Korean Academy of Tuberculosis and Respiratory Diseases.

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