Procollagen-3 Driven Corticosteroids for Persistent Acute Respiratory Distress Syndrome
Status:
Unknown status
Trial end date:
2021-06-15
Target enrollment:
Participant gender:
Summary
Unresolved ARDS is defined by the persistence of ARDS criteria at the end of the first week
of evolution despite an appropriate treatment of the cause of ARDS. A persistent ARDS is
associated with an increased mortality and prolonged lengths of mechanical ventilation, ICU
stay and hospitalization. Persistent ARDS is characterized by ongoing inflammation,
parenchymal-cell proliferation, and fibroproliferation leading to disordered deposition of
collagen. All of these pathways may be responsive to corticosteroid therapy.
Only two randomized controlled double-blinded trials assessed the use of corticosteroids for
persistent ARDS. In 24 patients, Meduri et al. reported an improvement of lung function and
survival (1). In 180 patients, Steinberg et al showed no effect of corticosteroids on
survival (2). A lower risk of death was observed when corticosteroids were started before 14
days after the onset of ARDS (2).
Alveolar procollagen III is validated as a biomarker of active fibroproliferation. Alveolar
procollagen III > 9 µg/L is associated to fibroproliferation (3).
As mortality was lower in patients who received corticosteroids while presenting a high
alveolar level of procollagen III on inclusion, Steinberg et al. showed that patients
presenting with a low level of procollagen III and treated with corticosteroids had an
increased risk of death (2).
Investigatores hypothesize that the use of procollagen III could improve personalized
decision-making regarding steroid treatment in patients presenting with persistent ARDS. The
future of anti-fibrotic treatment, including corticosteroids, in persistent ARDS might
propose to individualize the therapy according to the presence of an active
fibroproliferative phase (precision or personalized medicine).