Renal dysfunction reduces the diagnostic and prognostic value of serum CC16 for acute respiratory distress syndrome in i
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RESEARCH ARTICLE
Open Access
Renal dysfunction reduces the diagnostic and prognostic value of serum CC16 for acute respiratory distress syndrome in intensive care patients Jinle Lin1,2, Wuyuan Tao1,3, Jian Wei1, Jian Wu3*, Wenwu Zhang1* , Jianbing Ye1, Xuan Fu1, Shiyong Zeng1, Qingli Dou1, Lijun Wang3 and Fang Tian3
Abstract Background: Contradictory results regarding changes in serum club cell protein 16 (CC16) levels in patients with acute respiratory distress syndrome (ARDS) have been reported, challenging the value of CC16 as a diagnostic and prognostic marker for ARDS. We have also observed increased serum CC16 levels in patients with renal dysfunction (RD). Therefore, the present study aimed to determine whether RD affects the diagnostic performance of CC16 for ARDS in intensive care unit (ICU) patients. Methods: We measured serum CC16 concentrations in 479 ICU patients, who were categorized into six groups according to their diagnoses: control, acute kidney injury (AKI), chronic kidney disease (CKD), ARDS, ARDS+AKI, and ARDS+CKD. The sensitivity, specificity, and cutoff values for serum CC16 were assessed by receiver operating characteristic curve analysis. Results: Serum CC16 concentrations were higher in the ARDS group than in the control group, and in ARDS patients with normal renal function, serum CC16 could identify ARDS and predict survival outcomes at 7 and 28 days. However, serum CC16 levels were similar among the ARDS+AKI, ARDS+CKD, AIK, and CKD groups. Consequently, in patients with AKI and/or CKD, the specificity of CC16 for diagnosing ARDS or ARDS+RD decreased from 86.62 to 2.82% or 81.70 to 2.12%, respectively. Consistently, the CC16 cutoff value of 11.57 ng/ml in patients with RD differed from the established values of 32.77–33.72 ng/ml with normal renal function. Moreover, the predictive value of CC16 for mortality in ARDS+RD patients was lost before 7 days but regained by 28 days. Conclusion: RD reduces the diagnostic specificity, diagnostic cutoff value, and predictive value for 7-day mortality of serum CC16 for ARDS among ICU patients. Keywords: Acute respiratory distress syndrome, Acute kidney injury, Chronic kidney injury, Biomarkers, Club cell protein 16
* Correspondence: [email protected]; [email protected] 3 Department of Critical Care Medicine, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, Shenzhen 518101, Guangdong, China 1 Department of Emergency Medicine, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, 118 LongjingEr Road, Baoan, Shenzhen 518101, Guangdong, China Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other thi
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