Published online Sep 11, 2019. doi: 10.5492/wjccm.v8.i5.59
Peer-review started: May 5, 2019
First decision: June 6, 2019
Revised: July 2, 2019
Accepted: August 6, 2019
Article in press: August 7, 2019
Published online: September 11, 2019
Processing time: 134 Days and 3.9 Hours
Pneumonia and acute respiratory distress syndrome are common and important causes of respiratory failure in the intensive care unit with a significant impact on morbidity, mortality and health care utilization despite early antimicrobial therapy and lung protective mechanical ventilation. Both clinical entities are characterized by acute pulmonary inflammation in response to direct or indirect lung injury. Adjunct anti-inflammatory treatment with corticosteroids is increasingly used, although the evidence for benefit is limited. The treatment decisions are based on radiographic, clinical and physiological variables without regards to inflammatory state. Current evidence suggests a role of biomarkers for the assessment of severity, and distinguishing sub-phenotypes (hyper-inflammatory versus hypo-inflammatory) with important prognostic and therapeutic implications. Although many inflammatory biomarkers have been studied the most common and of interest are C-reactive protein, procalcitonin, and pro-inflammatory cytokines including interleukin 6. While extensively studied as prognostic tools (prognostic enrichment), limited data are available for the role of biomarkers in determining appropriate initiation, timing and dosing of adjunct anti-inflammatory treatment (predictive enrichment)
Core tip: Community acquired pneumonia and acute respiratory distress syndrome are common and important causes of respiratory failure in the intensive care unit. Both clinical entities are characterized by acute pulmonary inflammation in response to direct or indirect lung injury and current evidence suggests a role of biomarkers for the assessment of severity, and distinguishing sub-phenotypes (hyper-inflammatory versus hypo-inflammatory) with important prognostic and therapeutic implications.