• Ednan K Bajwa, Jessica A Volk, David C Christiani, R Scott Harris, Michael A Matthay, B Taylor Thompson, James L Januzzi, and National Heart, Lung and Blood Institute Acute Respiratory Distress Syndrome Network.
• 1Pulmonary and Critical Care Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA. 2Department of Medicine, Massachusetts General Hospital, Boston, MA. 3Department of Environmental Health, Harvard School of Public Health, Boston, MA. 4Department of Anesthesia, University of California San Francisco, San Francisco, CA. 5Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA.
• Crit. Care Med. 2013 Nov 1; 41 (11): 2521-31.

ObjectivesSoluble suppression of tumorigenicity-2 is a biomarker of myocardial strain and inflammation. The characteristics of acute respiratory distress syndrome include inflammation and cardiovascular dysfunction. We sought to determine whether plasma soluble suppression of tumorigenicity-2 concentration is associated with outcome and response to conservative fluid management and whether soluble suppression of tumorigenicity-2 concentration discriminates acute respiratory distress syndrome from decompensated heart failure.DesignA retrospective analysis of the Fluid and Catheter Treatment Trial, a multi-center randomized controlled trial of conservative fluid management in the acute respiratory distress syndrome, as well as of a cohort of patients with decompensated heart failure.SettingTwenty acute care hospitals.PatientsEight hundred twenty-six patients with acute respiratory distress syndrome and 209 patients with acutely decompensated heart failure.Measurements And Main ResultsNonsurvivors had higher day 0 (p < 0.0001) and day 3 (p < 0.0001) soluble suppression of tumorigenicity-2 concentrations. After adjustment for severity of illness, higher soluble suppression of tumorigenicity-2 concentration was associated with mortality, with odds ratioadj 1.47 (95% CI, 0.99-2.20; p = 0.06) at day 0, 2.94 (95% CI, 2.00-4.33; p < 0.0001) at day 3, and 3.63 (95% CI, 2.38-5.53; p < 0.0001) if soluble suppression of tumorigenicity-2 increased between days. Cumulative fluid balance was more positive among patients with higher day 0 (median, 5,212 mL [interquartile range, 200-12,284 mL] vs median, 2,020 mL [interquartile range, -2,034 to 7,091 mL]; p < 0.0001) and day 3 soluble suppression of tumorigenicity-2 (median, 7,678 mL [interquartile range, 2,217-14,278 mL] vs median, 1,492 mL [interquartile range, -2,384 to 6,239 mL]; p < 0.0001). Soluble suppression of tumorigenicity-2 showed excellent discriminative ability between the Fluid and Catheter Treatment Trial and heart failure populations (area under receiver-operating characteristic curve = 0.98; p < 0.0001).ConclusionsHigher soluble suppression of tumorigenicity-2 concentrations are associated with worse outcome in acute respiratory distress syndrome and may have value for discriminating acute respiratory distress syndrome from heart failure.

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