MMP-3 as a prognostic marker
SD, acute lung injury, ARDS
REGRESSION, ARDS, ACUTE RESPIRATORY DISTRESS SYNDROME
For the primary outcome, an AUROC curve analysis of day 3 MMP-3 concentration had an AUROC of 0.77 (95% confidence interval (CI): 0.67–0.87) for the prediction of 90-day mortality with an optimal cutoff value of 18.4 ng/mL (YI: 0.58) yielding a sensitivity of 92% and specificity of 63% (Fig. Receiver operating characteristic curves for MMP-3 prediction of 90-day mortality in ARDS. Receiver operating characteristics of Outcomes by MMP-3 concentration and change in MMP-3 from day 0 to 3All data are presented as n (%), mean ± SD, and median (interquartile range) unless otherwise notedALI: acute lung injury; ARDS: acute respiratory distress syndrome; APACHE III: Acute Physiology and Chronic Health Evaluation III; ICU: intensive care unit; MMP-3: matrix metalloproteinase-3; Vfd: ventilator free daysAmong patients with day 3 MMP-3 ≥ 18.4 ng/mL, 48% died at 90 days, while among those with MMP-3 values below 18.4 ng/mL, 4% died at 90 days (p < 0.001). The probability of survival at 90 days was 96% vs. 52% (p < 0.001) for patients with < 18.4 ng/mL. vs. ≥ 18.4 ng/mL day 3 MMP-3 concentrations and 90% vs. 42% for a change in MMP-3 from day 0 to 3 <  + 9.5 ng/mL and ≥  + 9.5 ng/mL, respectively. Figure Kaplan–Meier survival curves stratified by MMP-3 concentration and change in MMP-3. Association of MMP-3 and APACHE III with mortality by multivariate regressionMMP-3 variables were all individually tested in logistic regression with APACHE III score as covariates. Model variables that were iteratively removed stepwise included vasopressor use within the 24 h before randomization, PaOAPACHE III: Acute Physiology and Chronic Health Evaluation III; MMP-3: matrix metalloproteinase-3The change in baseline MMP-3 was also explored as a predictor of mortality. The change from MMP-3 from day 0 to 3 was elevated among those with mortality at 90 days (+ 14.5 ng/mL vs. + 3.7 ng/mL, p < 0.001). Day 0 to 3 MMP-3 change was predictive of mortality with an AUROC of 0.74 and an optimal cutoff value of + 9.5 ng/mL (YI: 0.54), providing 73% sensitivity and 81% specificity (Fig. 