Abstract
Purpose: Growth arrest-specific protein 6 (Gas6) is a vitamin K-dependent protein expressed by endothelial cells and leukocytes participating in cell survival, migration and proliferation and involved in many pathological situations. The aim of our study was to assess its implication in acute respiratory distress syndrome (ARDS) and its variation according to positive end expiratory pressure (PEEP) setting, considering that different cyclic stresses could alter Gas6 plasma levels.
Methods: Our patients were enrolled in the ExPress study comparing a minimal alveolar distension (“low PEEP”) ventilatory strategy to a maximal alveolar recruitment (“high PEEP”) strategy in ARDS. Plasma Gas 6, IL8 and VEGF levels were measured at day 0 and day 3 by enzyme-linked immunosorbent assay in blood samples prospectively collected during the study for a subset of 52 patients included in 8 centers during year 2005.
Results: We found that Gas6 plasma level was elevated in the whole population at day 0: 106 ng/mL (77-139), (median, IQR), with significant correlations with IL8, the Simplified Acute Physiologic Score II and the Organ Dysfunction and Infection (ODIN) scores. Statistically significant decreases in Gas6 and IL 8 plasma levels were observed between day 0 and day 3 in the “high PEEP” group (P=0.017); while there were no differences between day 0 and day 3 in the “low PEEP” group.
Conclusion: Gas6 plasma level is elevated in ARDS patients. The “high PEEP” strategy is associated with a decrease in Gas6 and IL8 plasma levels at day 3, without significant differences in day 28 mortality between the 2 groups.
Trial registration: clinicaltrials.gov Identifier: NCT00188058
Footnotes
- ↵*corresponding author. Tel : 33 1 56093201 ; fax : 33 1 56093202 ; mail : jldiehl{at}invivo.edu
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