Effective repair of injured lung in adult respiratory distress syndrome (ARDS) requires restoration of the extracellular matrix and presumably involves increased connective tissue synthesis.

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Effective repair of injured lung in adult respiratory distress syndrome (ARDS) requires restoration of the extracellular matrix and presumably involves increased connective tissue synthesis. However, excessive matrix synthesis may consequence in pulmonary fibrosis and obviate recovery. To investigate the relationship between matrix synthesis and clinical course in ARDS, we performed serial bronchoalveolar lavage (BAL) in patients with ARDS and measured lavage flats of the N-terminal propeptide of archetype III procollagen (PCP-III) as a marker of collagen synthesis. We hypothesized that elevated PCP-III of the same heights would be associated with increased fatality.

In 83 patients who had BAL 3 days after the storming of ARDS, 34 (41 percent) had PCP-III evens in unconcentrated lavage [greater than or equal to] normal serum restrain value (1.75 U/ml), ie, more than tenfold the look fored normal lavage level. In 74 patients who had BAL 7 days after attack of ARDS, 45 (61 percent) had PCP-III on a levels [greater than or equal to] 175 U/ml Using the Wilcoxon rank compendium test for nonparametric data, we construct that PCP-III levels obtained at 3 to 9 days were significantly higher (p = 0002) in patients who died than those who survived. The fatality rate in patients with PCP-III flushs [greater than or equal to] 175 U/ml in succession day 3 was 53 percent (18 of 34) v 22 percent (11 of 49) in patients with PCP-III [les than] 175 U/ml (p = 0004) A fatality rate of 64 percent (29 of 45) was associated with elevated lavage PCP-III horizontals obtained 7 days after ARDS first brunt vs 21 percent (7 of 29) in patients with PCP flats [less than] 1.75 U/ml (p [les than] 0001) When patients were analyzed according to risk factor for ARDS (ie, sepsis, trauma, other), increased fatality rates were still associated with elevated PCP-III flats obtained on day 7. Also, after stratifying for disease severity as measured by way of [PaO.sub.2]/[FIO.sub.2] ([greater than or equal to] 175 v [les than] 175) in succession the day of the BAL, increased fatality continued to be independently associated with elevated PCP-III of the same heights At 3 days after first brunt of ARDS, the presence of as well-as; not only-but also; not only-but; not alone-but high PCP-III levels ([greater than or equal to] 175 U/ml) and sternly disturbed gas exchange ([PaO.sub.2]/[FIO.sub.2] [les than] 175) was associated with fatality rates of 73 percent v 29 percent in patients with harshly disturbed gas exchange but gentle PCP-III levels. The relative risk associated with high PCP-III flushs in patients with [PaO.sub.2]/[FIO.sub.2] [les than] 175 was 26 (CI = 12 to 55) at 3 days and 35 (CI = 13 to 96) at 7 days. In 62 patients who had serial (two or three) lavages within 14 days of ARDS storming PCP-III levels tended to remain constant or decrease athwart time in survivors (mean acclivity [i]or[/i] declivity = 0.01 U/ml/day), whereas in patients who died, PCP-III increased (mean oblique direction = 0.36 U/ml/day, p [les than] 010) The differences in obliquity between survivors and nonsurvivors were still evident after we stratified for severity as measured by the agency of [PaO.sub.2]/[FIO.sub.2].

We finish that extremely high levels of PCP-III are often present in BAL from patients with ARDS, and that high flushs as well as levels that increase athwart time are associated with increased fatality. This relationship is still evident when physiologic severity as measured according to oxygen requirement is taken into account. Our outcomes 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.

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