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de Beer FM, Begieneman MPV, Roelofs JJTH, et al. Pulmonary complement depositions in autopsy of critically ill patients have no relation with ARDS. Intensive Care Med Exp. 2019;7:35doi: 10.1186/s40635-019-0237-2.
de Beer, F. M., Begieneman, M. P. V., Roelofs, J. J. T. H., Horn, J., Niessen, H. W. M., Schultz, M. J., & Lagrand, W. K. (2019). Pulmonary complement depositions in autopsy of critically ill patients have no relation with ARDS. Intensive care medicine experimental, 735. https://doi.org/10.1186/s40635-019-0237-2
de Beer, Friso M, et al. "Pulmonary complement depositions in autopsy of critically ill patients have no relation with ARDS." Intensive care medicine experimental vol. 7 (2019): 35. doi: https://doi.org/10.1186/s40635-019-0237-2
de Beer FM, Begieneman MPV, Roelofs JJTH, Horn J, Niessen HWM, Schultz MJ, Lagrand WK. Pulmonary complement depositions in autopsy of critically ill patients have no relation with ARDS. Intensive Care Med Exp. 2019 Jul 25;7:35. doi: 10.1186/s40635-019-0237-2. PMID: 31346823; PMCID: PMC6658633.
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Intensive Care Med Exp. 2019 Jul 25;7:35. doi: 10.1186/s40635-019-0237-2.

Pulmonary complement depositions in autopsy of critically ill patients have no relation with ARDS.

Intensive care medicine experimental

Friso M de Beer, Mark P V Begieneman, Joris J T H Roelofs, Janneke Horn, Hans W M Niessen, Marcus J Schultz, Wim K Lagrand

Affiliations

  1. Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. [email protected].
  2. Department of Intensive Care, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. [email protected].
  3. Department of Anesthesiology, Amsterdam University Medical Centers, Academic Medical Center, Room H1-118, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands. [email protected].
  4. Department of Pathology, Netherlands Forensic Institute, Den Haag, The Netherlands.
  5. Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
  6. Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
  7. Department of Intensive Care, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
  8. Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
  9. Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand.

PMID: 31346823 PMCID: PMC6658633 DOI: 10.1186/s40635-019-0237-2

Abstract

BACKGROUND: The complement system has frequently been suggested to play a role in the pathophysiology of acute respiratory distress syndrome (ARDS). The current study explored the association between pulmonary depositions of a complement activation product and the clinical diagnosis of ARDS.

METHODS: Lung tissue material from autopsied critically ill patients who died whilst on invasively mechanical ventilation was collected and stained for complement C3d. The diagnosis of ARDS was by the Berlin Definition. Lung injury scores (LIS) and driving pressures were calculated, 48 and 24 h prior to death. A pathologist who remained blinded for the clinical data scored the extent of C3d depositions, using a C3d deposition score (a minimum and maximum score of 0 and 24), and of diffuse alveolar damage (DAD). The primary analysis focused on the association between the C3d deposition score and the clinical diagnosis of ARDS. Secondary analyses focused on associations between the C3d deposition score and the presence of diffuse alveolar damage (DAD) in histopathology, and LIS and driving pressures in the last 2 days before death.

RESULTS: Of 36 patients of whom autopsy material was available, 12 were diagnosed as having had ARDS. In all patients, C3d depositions were found in various parts of the lungs, and to a different extent. Notably, C3d deposition scores were similar for patients with ARDS and those without ARDS (4.5 [3.3-6.8] vs. 5.0 [4.0-6.0]; not significant). C3d deposition scores were also independent from the presence or absence of DAD, and correlations between C3d scores and LIS and driving pressures prior to death were poor.

CONCLUSION: Pulmonary C3d depositions are found in the lungs of all deceased ICU patients, independent of the diagnosis of ARDS. The presence of complement C3d was not associated with the presence of DAD on histopathology and had a poor correlation with ventilation characteristics prior to death.

Keywords: ARDS; Autopsy; C3d; Complement; Complement activation; Complement deposition; Diffuse alveolar damage; Driving pressure; Intensive care; Lung injury score

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