Fibroproliferation in late adult respiratory distress syndrome. Pathophysiology, clinical and laboratory manifestations, and response to corticosteroid rescue treatment.

CHEST / 105/3 / MARCH, 1994 / Supplement 127S levels 1.75 U/mi on day 3 was 53 percent (18 of 34) vs 22 percent (11 of 49) in patients with PCP-III <1.75 U/ ml (p = 0.004). A fatality rate of 64 percent (29 of 45) was associated with elevated lavage PCP-III levels obtained 7 days after ARDS onset vs 21 percent (7 of 29) in patients with PCP levels <1.75 U/mi (p<O.OOl). When patients were analyzed according to risk factor for ARDS (1#{128}, sepsis, trauma, other), increased fatality rates were still associated with elevated PCP-III levels obtained on day 7. Also, after stratifying for disease severity as measured by PaO/F1o2 ( 175 vs <175) on the day of the BAL, increased fatality continued to be independently associated with elevated PCP-III levels. At 3 days after onset of ARDS, the presence of both high PCP-III levels ( 1.75 U/mi) and severely disturbed gas exchange (PaOIFIo2 <175) was associated with fatality rates of 73 percent vs 29 percent in patients with severely disturbed gas exchange but low PCP-III levels. The relative risk associated with high PCP-III levels in patients with Pa02/F1o2 <175 was 2.6 (CI = 1.2 to 5.5) at 3 days and 3.5 (CI = 1.3 to 9.6) at 7 days. In 62 patients who had serial (two or three) iavages within 14 days of ARDS onset, PCP-III levels tended to remain constant or decrease over time in survivors (mean slope = 0.01 U/milday), whereas in patients who died, PCP-III increased (mean slope = 0.36 U/mi/day, p<O.lO). The differences in slope between survivors and nonsurvivors were still evident after we stratified for severity as measured by PaO2/F1o2 We conclude that extremely high levels of PCP-III are frequently present in BAL from patients with ARDS, and that high levels as well as levels that increase over time are associated with increased fatality. This relationship is still evident when physiologic severity as measured by oxygen requirement is taken into account. Our results suggest that PCP-III levels may be useful in assessing metabolic activity in ARDS, and sustained activity may be associated with ongoing collagen production and progressive disease.