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doi:10.1378/chest.06-2596
(Chest. 2007; 131:1726-1734)
© 2007 American College of Chest Physicians
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Circulating Thymus- and Activation-Regulated Chemokine/CCL17 Is a Useful Biomarker for Discriminating Acute Eosinophilic Pneumonia From Other Causes of Acute Lung Injury*

Eishi Miyazaki, MD; Shin-ichi Nureki, MD; Emiko Ono, MD; Masaru Ando, MD; Osamu Matsuno, MD; Tetsujiro Fukami, MD; Takuya Ueno, MD and Toshihide Kumamoto, MD

* From the Divisions of Pulmonary Diseases (Drs. Miyazaki, Nureki, Ono, Ando, Matsuno, Fukami, and Ueno) and Neurology and Neuromuscular Disorders (Dr. Kumamoto), Department of Brain and Nerve Science, Oita University Faculty of Medicine, Oita, Japan.

Correspondence to: Eishi Miyazaki, MD, PhD, Division of Pulmonary Disease, Department of Brain and Nerve Science, Oita University Faculty of Medicine, 1–1 Idaigaoka, Hasama-machi, Oita 879-5593, Japan; e-mail: eishida{at}med.oita-u.ac.jp

Abstract

Background: The presentation of acute eosinophilic pneumonia (AEP) closely resembles that of acute lung injury (ALI)/ARDS, including its idiopathic form, acute interstitial pneumonia (AIP). AEP usually lacks peripheral eosinophilia at the acute phase; therefore, the establishment of serum biomarkers for AEP would be clinically useful.

Methods: We measured the levels of thymus- and activation-regulated chemokine (TARC)/CCL17, eotaxin/CCL11, KL-6, and surfactant protein-D (SP-D) in serum for patients with acute parenchymal lung diseases including AEP (n = 17), AIP (n = 13), pneumonia-associated ALI/ARDS (n = 12), and alveolar hemorrhage (n = 7). To evaluate diagnostic ability, each marker was estimated by measuring the area under the receiver operating characteristic curve (AUC).

Results: Serum TARC/CCL17 levels of AEP patients were much higher than those of patients in other disease groups. More importantly, high circulating TARC/CCL17 levels were observed in AEP even at acute phase when peripheral eosinophilia was absent. TARC/CCL17 showed the largest AUC, and the TARC/CCL17 levels with cutoff points from 6,259 to 7,039 pg/mL discriminated AEP from other syndromes with sensitivity and specificity of 100%. The KL-6 level was low in most patients with AEP, and the sensitivity was 81.6% in cutoff with 100% specificity. The AUC for eotaxin/CCL11 and SP-D was small, with values of 0.73 (95% confidence interval [CI], 0.60 to 0.86) and 0.53 (95% CI, 0.31 to 0.64), respectively.

Conclusions: This study indicates that the measurement of circulating TARC/CCL17 and KL-6 is useful for discriminating AEP from other causes of ALI.

Key Words: acute eosinophilic pneumonia • acute lung injury • KL-6 • serum biomarker • thymus- and activation-regulated chemokine






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