Predictive values of IGF1, IGFBP3 and PCT for patients with sepsis-induced acute respiratory distress syndrome.

OBJECTIVES: To explore the predictive value of serum IGF1, IGFBP3 and PCT for the development and prognosis of sepsis-induced ARDS. METHODS: A total of 276 septic patients enrolled were divided into an ARDS group (144 cases) and a non-ARDS control group (132 cases). On admission, APACHE II and SOFA Scores were calculated, and serum PCT, IGF1, and IGFBP3 were measured. The differences of clinical and biomarkers between groups were analyzed using a Mann-Whitney U test. Multivariable logistic regression was used to screen independent risk factors for sepsis-induced ARDS and its mortality. ROC curves were used to evaluate the predictive value of single and combined biomarkers for the occurrence of ARDS in septic patients. RESULTS: Compared with controls, patients with sepsis-induced ARDS exhibited significantly lower serum IGFBP3 and IGF1 but higher PCT concentrations. Serum IGFBP3 was negatively correlated with APACHE II scores (r = -0.20, P = 0.019), while serum PCT was positively correlated with both SOFA (r = 0.26, P = 0.0014) and APACHE II scores (r = 0.24, P = 0.044). Septic shock, elevated SOFA score, increased PCT and reduced IGF1 were independent risk factors for sepsis-induced ARDS. The combination of IGF1, PCT and SOFA score achieved an AUC of 0.80, superior to any single indicator alone. Among ARDS patients, non-survivors presented markedly lower serum IGF1 and IGFBP3 levels than survivors, with no intergroup difference in serum PCT. Higher serum IGFBP3 was independently associated with lower odds of mortality. CONCLUSION: Aberrant expressions of circulating IGF1, IGFBP3 and PCT are closely linked to the severity in patients with sepsis-induced ARDS. The combination of serum PCT and IGF1, and SOFA scores had a good predictive performance for identifying septic patients at high risk of ARDS. Serum IGFBP3 can serve as a valuable biomarker to evaluate the outcomes of sepsis-induced ARDS.