Biomarkers in Traumatic Lung Injury - A Systematic Review

Traumatic lung injury (TLI) significantly contributes to global morbidity and mortality, often progressing to acute lung injury or acute respiratory distress syndrome. Early biomarkers could improve diagnosis, prognosis, and treatment strategies.

A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted in PubMed, Cochrane Library, and Web of Science. Studies on biomarkers for acute parenchymal lung injury in trauma patients were included, excluding nontrauma and prophylactic studies. Biomarkers were assessed for sensitivity, specificity, and clinical relevance.

Thirty studies identified biomarkers related to epithelial damage (e.g. club cell protein 16 [CC16], CYFRA21-1), endothelial injury (e.g. soluble receptor for advanced glycation end-products [sRAGE], Angiopoietin 2), inflammation (e.g. interleukins), and coagulation (e.g. D-dimer). CC16 and sRAGE showed potential for early acute lung injury diagnosis, while interleukins predicted acute respiratory distress syndrome severity. Transient biomarker peaks aligned with acute pathophysiology but varied by protocol, complicating clinical use.

Biomarkers show promise for early TLI diagnosis and stratification. CC16, sRAGE, and angiopoietin 2 emerge as the most promising biomarkers for prognosticating the severity of TLI.