Clinical value of combined serum biomarker detection for early prediction of pediatric acute respiratory distress syndrome

doi:10.3969/j.issn.1004-583X.2025.03.008

Abstract

Abstract:

Objective To investigate the clinical predictive value of serum Krebs von den Lungen-6 (KL-6), von Willebrand factor (vWF), and interleukin-8 (IL-8) in the early identification of pediatric acute respiratory distress syndrome (pARDS). Methods A total of 92 children who received mechanical ventilation in the Department of Pediatric Intensive Care Unit of the Third Affiliated Hospital of Zhengzhou University from November 2023 to November 2024 were included. According to the development of pARDS within 7 days after the confirmation of etiological damages, included children were divided into the pARDS group (n=35) and non-pARDS group (n=57). Serum biomarker levels were measured using enzyme-linked immunosorbent assay (ELISA) at the initiation of mechanical ventilation (T₁) in both groups, the time of pARDS diagnosis (T₂), and on the third day post-diagnosis (T₃) in the pARDS group. Relevant clinical data were collected and analyzed. Results At T₁, the levels of KL-6, vWF, and IL-8 were significantly higher in the pARDS group compared to the non-pARDS group (P<0.05). The levels of KL-6, vWF and IL-8 in the pARDS group were significantly different at different time points (P<0.05). The level of KL-6 at T₂ was significantly higher than that at T₁, and reached the peak at T₃ (P<0.01). The levels of IL-8 and vWF reached the peak at T₂ and then decreased at T₃ (P<0.05). Receiver operating characteristic (ROC) curve analysis demonstrated that the area under the curve (AUC) of KL-6, IL-8, and vWF in diagnosing pARDS was 0.749, 0.662, and 0.631, respectively, with the sensitivity of 74.3%, 62.9%, and 62.9%, and specificity of 82.5%, 61.4%, and 68.4%. When combined, the AUC reached 0.776(P<0.05), with the corresponding sensitivity of 85.7%, and specificity of 63.2%. Conclusion Elevated serum levels of KL-6, IL-8, and vWF are effective biomarkers for the early identification of pARDS. A combined detection of these biomarkers can improve diagnostic accuracy.

Key words: respiratory distress syndrome, Krebs von den Lungen-6, interleukin-8, von Willebrand factor

CLC Number:

R563.8

Feng Yuhui, Zou Lanlan, Cui Chenhang, Huang Xianjie, Qiao Junying. Clinical value of combined serum biomarker detection for early prediction of pediatric acute respiratory distress syndrome[J]. Clinical Focus, 2025, 40(3): 237-242.

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URL: http://www.lchc.cn/EN/10.3969/j.issn.1004-583X.2025.03.008

http://www.lchc.cn/EN/Y2025/V40/I3/237

Figures/Tables 5

References 22

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指标	pARDS组(n=35)	非pARDS组(n=57)	统计值	P值
年龄(月)	9.80(2.77, 12.50)	10.37(2.02, 18.00)	Z=0.076	0.939
体重(kg)	8.20(5.00, 10.50)	8.50(4.00, 10.00)	Z=1.127	0.260
男性[例(%)]	24(68.6)	34(59.6)	χ²=0.741	0.389
白细胞(×10⁹/L)	10.84(6.74, 14.77)	9.61(6.55, 15.73)	Z=0.197	0.844
血小板(×10⁹/L)	350(257, 523)	314(236, 441)	Z=0.993	0.321
肌酐( μmol/L)	20.30(16.70, 26.00)	18.80(16.00, 23.44)	Z=0.768	0.442
D-二聚体(mg/L)	0.35(0.27, 0.60)	0.47(0.28, 1.09)	Z=1.693	0.090
总蛋白(g/L)	57.38±8.26	55.30±10.41	t=1.005	0.318
白蛋白(g/L)	35.57±6.12	34.83±6.98	t=0.519	0.605
PCIS评分(分)	80.17±4.93	82.60±4.39	t=2.453	0.016
机械通气时长(h)	199(150, 277)	104 (29, 131)	Z=5.825	0.000
住院天数(d)	23.00(17.00, 27.00)	18.00(13.00, 27.50)	Z=1.787	0.074
原发疾病[例(%)]			χ²=3.661	0.300
肺炎	20(57.1)	29(50.9)
脓毒症	9(25.7)	9(15.8)
大手术术后	4(11.4)	15(26.3)
其他	2(5.7)	4(7.0)

指标	pARDS组(n=35)	非pARDS组(n=57)	统计值	P值
年龄(月)	9.80(2.77, 12.50)	10.37(2.02, 18.00)	Z=0.076	0.939
体重(kg)	8.20(5.00, 10.50)	8.50(4.00, 10.00)	Z=1.127	0.260
男性[例(%)]	24(68.6)	34(59.6)	χ²=0.741	0.389
白细胞(×10⁹/L)	10.84(6.74, 14.77)	9.61(6.55, 15.73)	Z=0.197	0.844
血小板(×10⁹/L)	350(257, 523)	314(236, 441)	Z=0.993	0.321
肌酐( μmol/L)	20.30(16.70, 26.00)	18.80(16.00, 23.44)	Z=0.768	0.442
D-二聚体(mg/L)	0.35(0.27, 0.60)	0.47(0.28, 1.09)	Z=1.693	0.090
总蛋白(g/L)	57.38±8.26	55.30±10.41	t=1.005	0.318
白蛋白(g/L)	35.57±6.12	34.83±6.98	t=0.519	0.605
PCIS评分(分)	80.17±4.93	82.60±4.39	t=2.453	0.016
机械通气时长(h)	199(150, 277)	104 (29, 131)	Z=5.825	0.000
住院天数(d)	23.00(17.00, 27.00)	18.00(13.00, 27.50)	Z=1.787	0.074
原发疾病[例(%)]			χ²=3.661	0.300
肺炎	20(57.1)	29(50.9)
脓毒症	9(25.7)	9(15.8)
大手术术后	4(11.4)	15(26.3)
其他	2(5.7)	4(7.0)

指标	例数	KL-6 (ng/ml)	IL-8 (pg/ml)	vWF (μg/ml)
pARDS组	35	3.33(2.44, 4.05)	45.39(33.94, 65.30)	5.81±1.53
非pARDS组	57	2.13(1.50, 2.68)	36.74(19.21, 48.95)	4.86±2.12
统计值		Z=3.993	Z=2.598	t=2.489
P值		0	0.009	0.015

指标	例数	KL-6 (ng/ml)	IL-8 (pg/ml)	vWF (μg/ml)
pARDS组	35	3.33(2.44, 4.05)	45.39(33.94, 65.30)	5.81±1.53
非pARDS组	57	2.13(1.50, 2.68)	36.74(19.21, 48.95)	4.86±2.12
统计值		Z=3.993	Z=2.598	t=2.489
P值		0	0.009	0.015

	KL-6 (ng/ml)	IL-8 (pg/ml)	vWF (μg/ml)
T₁	3.33(2.44, 4.05)	45.39(33.94, 65.30)	5.81±1.53
T₂	5.19(3.02, 6.72)^*	76.24(45.71, 109.75)^*	6.72±1.94^*
T₃	6.47(5.11, 8.47)^#	53.78(36.19, 76.87)^#	5.66±1.71^#
统计值	H=36.289	H=10.006	F=3.824
P值	0	0.007	0.025