• Olivier Lesur, Stephan Langevin, Yves Berthiaume, Martin Légaré, Yoanna Skrobik, Jean-François Bellemare, Bruno Lévy, Yvan Fortier, Francois Lauzier, Gina Bravo, Marc Nickmilder, Eric Rousseau, Alfred Bernard, and Critical Care Research Group of the Québec Respiratory Health Network.
• Groupe de Recherche en Physiopathologie Respiratoire, Centre de Recherche Clinique, Centre Hospitalier Universitaire de Sherbrooke 3001, 12 Avenue Nord, Sherbrooke, Canada. Olivier.Lesur@USherbrooke.ca
• Intensive Care Med. 2006 Aug 1;32(8):1167-74.

ObjectiveInjury to the alveolocapillary barrier characterizes ALI/ARDS; therefore determining levels of lung epithelium-specific small proteins in serum may help predict clinical outcomes. We examined whether serum Clara cell protein (CC-16) concentration is correlated with the outcome, mechanical ventilation duration, and incidence of nonpulmonary organ failure.DesignProspective multicenter observational study conducted by the Quebec Critical Care Network.MeasurementsSeventy-eight adult ARDS patients requiring mechanical ventilation were enrolled and 28-day mortality was the primary outcome. Ventilatory parameters were computed and blood was sampled daily. Clinical information collected included cause of death, duration of mechanical ventilation, number of ventilator-free days, and organ failures.ResultsMedian serum levels of CC-16 were significantly higher in nonsurvivors than survivors on days 0-2 (19.93 microg/l, IQR 11.8-44.32, vs. 8.9, 5.66-26.38) and sustained up to day 14. CC-16 levels were correlated positively with the number of failing organs (rho 0.3623) and requirement for prolonged mechanical ventilation. Predictors of patient mortality included age, arterial carbon dioxide partial pressure, CC-16, and APACHE II score (odds ratios 1.35, 1.52, 1.37, 1.159, respectively).ConclusionsHigher initial CC-16 serum level is associated with increased risk of death, fewer ventilator-free days, and increased frequency of nonpulmonary multiple organ failure. CC-16 is a valuable biomarker of ARDS that may help predict outcome among ARDS patients with high-risk mortality.

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