CYFRA21-1 is a more sensitive biomarker to assess the severity of pulmonary alveolar proteinosis.

BACKGROUND: Serum lactate dehydrogenase (LDH), carcinoembryonic antigen (CEA) and CYFRA21-1 are the commonly used biomarkers to identify patients with autoimmune pulmonary alveolar proteinosis (APAP). However, it is not clear which of the biomarkers is more sensitive to the severity of the patient's condition. METHODS: APAP patients numbering 151 were enrolled in this study. All patients' severity was assessed through the severity and prognosis score of PAP (SPSP). According to the respective laboratory upper limits of serum levels of LDH, CEA and CYFRA21-1, APAP patients were divided into higher and lower-level groups. Patients were divided into five groups based on SPSP. 88 patients had completed six months of follow-up. We calculated sensitivity, specificity, and critical point of LDH, CEA and CYFRA21-1 between APAP patients and normal control group, and between grade 1-2 and 3-5 through receiving operating characteristics (ROC) curve. RESULTS: Serum LDH, CEA and CYFRA21-1 levels of patients with PAP were higher and distinctly related to PaO2, FVC, FEV1, DLCO, HRCT scores and SPSP. The SPSP of patients in higher-level LDH, CEA and CYFRA21-1 groups were higher than those of corresponding lower-level groups. Based on SPSP results, the patients were divided into five groups (grade I, 20; grade II, 37; grade III, 40; grade IV, 38; grade V, 16). The serum level of CYFRA21-1 of patients with APAP in grade II was higher than that of patients in grade I and lower than that of patients in grade III. Serum CYFRA21-1 of patients with APAP after six months were higher than the baseline among the aggravated group. Serum LDH, CEA and CYFRA21-1 levels after six months among patients in the relieved group of patients with APAP were lower than the baseline. ROC correlating LDH, CEA and CYFRA21-1 values with APAP severity (between grade 1-2 and 3-5) showed an optimal cutoff of LDH of over 203 U/L (< 246 U/L), CEA of over 2.56 ug/L (< 10 ug/L), and CYFRA21-1 of over 5.57 ng/ml (> 3.3 ng/ml) (AUC: 0.815, 95% CI [0.748-0.882], sensitivity: 0.606, specificity: 0.877). CONCLUSION: Serum CYFRA21-1 level was more sensitive in revealing the severity of APAP than LDH and CEA levels among mild to moderate forms of disease.

The effect of blood lactate and NT-proBNP predict the survival in patients with invasive mechanical ventilation.

BACKGROUND: Respiratory failure is one of the most common critical diseases. It has already been reported that invasive mechanical ventilation (IMV) should be used to treat respiratory failure. The present study aims to evaluate the prognostic value of blood lactate and NT-proBNP in patients with IMV. METHODS: We retrospectively included 353 patients who were hospitalized in the emergency department of Shanghai Sixth People's Hospital from 2016 to 2019. All patients had IMV. R&D Human Premixed Multi-Analyte Kit detected the expression of various inflammatory factors in serum. Receiver operating characteristic (ROC) curve analysis, survival analysis, and multivariate cox proportional hazards analysis were implemented as statistical analysis methods. RESULTS: The mean duration of hospitalization was 25.5±20.6 days. Twenty-four men and 41 women died. Compared with the survivors, the nonsurvivors were older, had different types of diagnosis, longer ventilation time, and shorter survival time (P<0.05). Also, the expression levels of PCT, NT-proBNP, lactate in 12 h and lactate in 24 h in the nonsurvivors were significantly higher than those in the survivor group (P<0.05). There was a significant correlation between these parameters and ventilation times (P<0.001). The results showed that age, NT-proBNP, and lactate were independent predictors of survival rate. ROC analysis showed that the cut-off values of age, NT-proBNP and lactate were 61.5 years, 230.5 pg/mL and 3.7 mmol/L, respectively. Patients aged ≥61.5 years or NT-proBNP ≥230.5 pg/mL or lactate ≥3.7 mmol/L had a worse prognosis. Therefore, patients with three parameters higher than cut-off value had the lowest survival rate, while patients with three parameters lower than cut-off value had the best survival rate. CONCLUSIONS: Blood lactate and NT-proBNP may be used as biomarkers to predict the prognosis of patients undergoing IMV.