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Associations of Inflammatory Biomarkers with Disease Severity in Elderly Patients with Sepsis-Associated ARDS: A
Shenhua Chen1, Liangfu Han2, Peng Wang2
1Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China.
Background:
Sepsis-associated acute respiratory distress syndrome (ARDS) is associated with high mortality, particularly in elderly patients. Reliable biomarkers for early severity stratification remain limited.
Objective:
To evaluate the associations of four inflammatory biomarkers-endothelial cell-specific molecule-1 (ESM-1), soluble urokinase plasminogen activator receptor (suPAR), procalcitonin (PCT), and heparin-binding protein (HBP)-with disease severity in elderly patients with sepsis-associated ARDS.
Methods:
This cross-sectional study included 168 elderly patients (≥60 years) with sepsis-associated ARDS. Serum levels of ESM-1, suPAR, PCT, and HBP were measured at enrollment. Disease severity was assessed using the APACHE II, SOFA, and MLIS scores, and the PaO2/FiO2 ratio. Correlations were examined using Spearman's rank correlation coefficients. Multivariable logistic regression was performed to identify biomarkers independently associated with moderate-to-severe ARDS, and receiver operating characteristic (ROC) curves were generated to evaluate their discriminative ability.
Results:
All four biomarkers increased stepwise across the mild, moderate, and severe ARDS groups (all P < 0.001). ESM-1 showed the strongest correlation with ARDS severity (r = 0.557, P < 0.001) and the largest area under the ROC curve (AUC = 0.800, 95% CI: 0.728-0.872), followed by HBP (AUC = 0.773), PCT (AUC = 0.761), and suPAR (AUC = 0.704). After adjustment for age and sex, ESM-1 (OR = 3.302, 95% CI: 1.596-6.832, P = 0.001), PCT (OR = 1.409, 95% CI: 1.137-1.747, P = 0.002), and HBP (OR = 1.039, 95% CI: 1.017-1.061, P < 0.001) remained independently associated with moderate-to-severe ARDS.
Conclusion:
ESM-1, PCT, and HBP are independently associated with disease severity in elderly patients with sepsis-associated ARDS. ESM-1 demonstrated discriminative ability comparable to conventional severity scores and may serve as an adjunctive marker for severity assessment at enrollment, pending prospective validation. Limitations include the single-center, cross-sectional design and the lack of external validation.