Abstract:

Objective To investigate the relationship between the expression of serum vascular cell adhesion molecule-1 （VCAM-1） and miR-181b-5p and the severity and prognosis of acute respiratory distress syndrome （ARDS） patients. Methods A total of 128 ARDS patients from Nanyang Central Hospital from October 2020 to October 2023 were enrolled. All the patients were classified into mild group （42 cases），moderate group（50 cases）and severe group （36 cases） according to oxygenation index. The clinical data were collected，and white blood cell （WBC） count and serum VCAM-1，tumor necrosis factor-alpha（TNF-α），interleukin （IL）-6，IL^-1β and miR-181b-5p were determined. All the patients were followed up for 30 d，and the survival status of the patients was recorded. Pearson correlation analysis was used to evaluate the correlation between serum VCAM-1 and miR-181b-5p and the acute physiology and chronic health evaluationⅡ（APACHEⅡ） score，TNF-α，IL-6 and IL^-1β at admission. Logistic regression analysis was used to evaluate the influencing factors of death in ARDS patients. Receiver operating characteristic （ROC） curve was used to evaluate the efficacy of serum VCAM-1 and miR-181b-5p in predicting death in ARDS patients. Results The serum VCAM-1 levels in mild，moderate and severe groups were increased successively （P<0.001），and the relative expression levels of miR-181b-5p were decreased successively （P<0.001）. Compared with survival group，the APACHEⅡscore and serum TNF-α，IL^-1β，IL-6 and VCAM-1 levels in death group were increased （P<0.001），and the oxygenation index and the relative expression level of miR-181b-5p were decreased （P<0.001）. Serum VCAM-1 in ARDS patients was positively correlated with TNF-α，IL^-1β，IL-6 and APACHEⅡscore （r values were 0.458，0.397，0.412 and 0.527，respectively，P<0.001），and it was negatively correlated with miR-181b-5p （r=-0.389，P<0.001）. The miR-181b-5p was negatively correlated with TNF-α，IL^-1β，IL-6 and APACHEⅡscore （r values were -0.425，-0.399，-0.431 and -0.504，respectively，P<0.001）. Elevated TNF-α，IL^-1β，IL-6，VCAM-1 and decreased oxygenation index and miR-181b-5p were all risk factors for death in ARDS patients （P<0.05）. The areas under curves （AUC） of single determinations and combined determination of serum VCAM-1 and miR-181b-5p for predicting death in ARDS patients were 0.863，0.846 and 0.943，respectively. Conclusions The levels of serum VCAM-1 and the expression of miR-181b-5p are related to the severity of ARDS，and the combined determination has certain predictive value for the prognosis of patients.

Key words: Vascular cell adhesion molecule-1, MicroRNA-181b-5p, Acute respiratory distress syndrome