Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jan 27;61(2):229.
doi: 10.3390/medicina61020229.

sRAGE as a Prognostic Biomarker in ARDS: Insights from a Clinical Cohort Study

Ana Andrijevic  1   2 , Uros Batranovic  2 , Djordje Nedeljkov  2 , Srdjan Gavrilovic  1   2 , Vladimir Carapic  1   2 , Svetislava Milic  2 , Jovan Matijasevic  1   2 , Ilija Andrijevic  1   2
Affiliations

sRAGE as a Prognostic Biomarker in ARDS: Insights from a Clinical Cohort Study

Ana Andrijevic et al. Medicina (Kaunas). .

Abstract

Background and Objectives: Acute respiratory distress syndrome (ARDS) is a severe form of acute lung injury with high mortality, characterized by hypoxemic respiratory failure and diffuse lung damage. Despite advancements in care, no definitive biomarkers have been established for ARDS diagnosis and prognostic stratification. Soluble receptor for advanced glycation end-products (sRAGE), a marker of alveolar epithelial injury, has shown promise as a prognostic indicator in ARDS. This study evaluates sRAGE's utility in predicting 28-day mortality. Materials and Methods: A retrospective cohort study was conducted at a tertiary care ICU in Serbia from January 2021 to June 2023. Adult patients meeting the Berlin definition of ARDS were included. Exclusion criteria included pre-existing chronic respiratory diseases and prolonged mechanical ventilation before diagnosis. Serum sRAGE levels were measured within 48 h of ARDS diagnosis using enzyme-linked immunosorbent assay (ELISA). Clinical severity scores, laboratory markers, and ventilatory parameters were recorded. Logistic regression and survival analyses were used to assess the prognostic value of sRAGE for 28-day mortality. Results: A cohort of 121 patients (mean age 55.5 years; 63.6% male) was analyzed. Non-survivors exhibited higher median sRAGE levels than survivors (5852 vs. 4479 pg/mL, p = 0.084). The optimal sRAGE cut-off for predicting mortality was >16,500 pg/mL (sensitivity 30.4%, specificity 86.9%). Elevated sRAGE levels were associated with greater disease severity and an increased risk of 28-day mortality in ARDS patients, highlighting its potential as a prognostic biomarker. The main findings, while indicative of a trend toward higher sRAGE levels in non-survivors, did not reach statistical significance. Conclusions: The main findings, while indicative of a trend toward higher sRAGE levels in non-survivors, did not reach statistical significance (p = 0.084). sRAGE demonstrates potential as a prognostic biomarker in ARDS and has moderate correlation with 28-day mortality. Integrating sRAGE with other biomarkers could enhance risk stratification and guide therapeutic decisions. The retrospective design limits the ability to establish causation, underscoring the need for multicenter prospective studies.

Keywords: ARDS; ICU; biomarkers; mortality; sRAGE.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Cumulative survival in ARDS patients.
Figure 2
Figure 2
Box–Whisker plot of sRAGE and mortality at day 28.
Figure 3
Figure 3
ROC curve of sRAGE and mortality at day 28.
Figure 4
Figure 4
(A–D) The distribution of sRAGE values in relation to mortality outcomes. Panels (A,B) show the density distribution of ICU length of stay for 28-day survivors and non-survivors, with higher sRAGE levels (blue) correlating with longer ICU stays in survivors. Panels (C,D) depict the ventilator-free day distributions, revealing that higher sRAGE levels are associated with fewer ventilator-free days, particularly in non-survivors (D). The y-axis in each panel represents the density of the distribution, indicating the relative frequency of the corresponding x-axis values.
See this image and copyright information in PMC

References

    1. Spadaro S., Park M., Turrini C., Tunstall T., Thwaites R., Mauri T., Ragazzi R., Ruggeri P., Hansel T.T., Caramori G., et al. Biomarkers for Acute Respiratory Distress syndrome and prospects for personalised medicine. J. Inflamm. 2019;16:1. doi: 10.1186/s12950-018-0202-y. - DOI - PMC - PubMed
    1. Ferguson N.D., Fan E., Camporota L., Antonelli M., Anzueto A., Beale R., Brochard L., Brower R., Esteban A., Gattinoni L., et al. The Berlin definition of ARDS: An expanded rationale, justification, and supplementary material. Intensive Care Med. 2012;38:1573–1582. doi: 10.1007/s00134-012-2682-1. - DOI - PubMed
    1. Gattinoni L., Vassalli F., Romitti F. Benefits and risks of the P/F approach. Intensive Care Med. 2018;44:2245–2247. doi: 10.1007/s00134-018-5413-4. - DOI - PubMed
    1. Papazian L., Aubron C., Brochard L., Chiche J.-D., Combes A., Dreyfuss D., Forel J.M., Guérin C., Jaber S., Mekontso-Dessap A., et al. Formal guidelines: Management of acute respiratory distress syndrome. Ann. Intensive Care. 2019;9:69. doi: 10.1186/s13613-019-0540-9. - DOI - PMC - PubMed
    1. Bellani G., Laffey J.G., Pham T., Fan E., Brochard L., Esteban A., Gattinoni L., Van Haren F., Larsson A., McAuley D.F., et al. Epidemiology, Patterns of Care, and Mortality for Patients with Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries. JAMA. 2016;315:788. doi: 10.1001/jama.2016.0291. - DOI - PubMed

Substances

LinkOut - more resources