Case Control Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 16, 2021; 9(32): 9731-9740
Published online Nov 16, 2021. doi: 10.12998/wjcc.v9.i32.9731
Correlation between circulating endothelial cell level and acute respiratory distress syndrome in postoperative patients
Min Peng, Qing-He Yan, Ying Gao, Zhen Zhang, Ying Zhang, Yi-Feng Wang, He-Ning Wu
Min Peng, Qing-He Yan, Ying Gao, Zhen Zhang, Ying Zhang, Yi-Feng Wang, He-Ning Wu, Department of Intensive Care Unit, Tianjin Medical University General Hospital, Tianjin 300070, China
Author contributions: Peng M conceived and coordinated the study, designed, performed, and analyzed the experiments, and wrote the article; Yan QH and Gao Y carried out the data collection; Zhang Z, Zhang Y, Wang YF and Wu HN performed the data analysis; All authors reviewed the results and approved the final version of manuscript.
Supported by Science and Technology Development Fund Program of Higher Education of Tianjin, No. 20120121.
Institutional review board statement: The study was approved by the Ethics Committees of Tianjin Medical University General Hospital (No. IRB2014-YX-002).
Informed consent statement: All patients signed the informed consent form.
Conflict-of-interest statement: All authors declare that they have no competing interests.
Data sharing statement: Not applicable.
STROBE statement: The manuscript was checked according to the STROBE.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Min Peng, MD, Chief Physician, Department of Intensive Care Unit, Tianjin Medical University General Hospital, No. 154 Anshan Street, Heping District, Tianjin 300070, China. pengmin2021@sina.com
Received: June 30, 2021
Peer-review started: June 30, 2021
First decision: July 26, 2021
Revised: August 27, 2021
Accepted: September 24, 2021
Article in press: September 24, 2021
Published online: November 16, 2021
Abstract
BACKGROUND

Acute respiratory distress syndrome (ARDS) is injury of alveolar epithelial cells and capillary endothelial cells caused by various factors, including endogenous and exogenous lung factors, leading to diffuse pulmonary interstitial and alveolar edema, and acute respiratory failure. ARDS involves alveolar epithelial cells and pulmonary interstitial capillary endothelial cells. Circulating endothelial cells (CECs) are the only marker that directly reflects vascular endothelial injury in vivo. There have been few studies on the correlation between peripheral blood CECs and ARDS at home and abroad. The lungs are the organs with the highest capillary density and the most endothelial cells, thus, it is speculated that when ARDS occurs, CECs are stimulated and damaged, and released into the circulatory system.

AIM

To explore the correlation between CEC level and severity of ARDS in patients postoperatively.

METHODS

Blood samples were collected from all patients on day 2 (d2) and day 5 (d5) after surgery. The control group comprised 32 healthy volunteers. Number of CECs was measured by flow cytometry, and operation time was recorded. Changes in various indexes of patients were monitored, and diagnosis of ARDS was determined based on ARDS Berlin definition. We comprised d2 CECs in different groups, correlation between operation time and d2 CECs, ARDS of different severity by d2 CECs, and predictive value of d2 CECs for ARDS in postoperative patients.

RESULTS

The number of d2 CECs in the ARDS group was significantly higher than that in the healthy control group (P < 0.001). The number of d2 CECs in the ARDS group was significantly higher than that in the non-ARDS group (P < 0.001). The number of d2 CECs in the non-ARDS group was significantly higher than that in the healthy control group (P < 0.001). Operation time was positively correlated with number of CECs on d2 (rs = 0.302, P = 0.001). The number of d2 CECs in the deceased group was significantly higher than that in the improved group (P < 0.001). There was no significant difference in number of d2 CECs between patients with mild and moderate ARDS. The number of d2 CECs in patients with severe ARDS was significantly higher than that in patients with mild and moderate ARDS (P = 0.041, P = 0.037). There was no significant difference in number of d5 and d2 CECs in the non-ARDS group after admission to intensive care. The number of d5 CECs was higher than the number of d2 CECs in the ARDS improved group (P < 0.001). The number of d5 CECs was higher than the number of d2 CECs in the ARDS deceased group (P = 0.002). If the number of CECs was > 1351/mL, sensitivity and specificity of predicting ARDS were 80.8% and 78.1%, respectively.

CONCLUSION

Changes in number of CECs might predict occurrence and adverse outcome of ARDS after surgery, and higher numbers of CECs indicate worse prognosis of ARDS.

Keywords: Circulating endothelial cells, Acute respiratory distress syndrome, Intensive care unit, Postoperative period, Outcome, Flow cytometry

Core Tip: This manuscript evaluated the changes in number of circulating endothelial cells (CECs) might predict occurrence and adverse outcome of acute respiratory distress syndrome (ARDS) postoperatively, and higher numbers of CECs are associated with a worse prognosis of ARDS.