Surfactant Protein D Is Associated With Severe Pediatric ARDS, Prolonged Ventilation, and Death in Children With Acute Respiratory Failure

Mary K. Dahmer, Heidi Flori, Anil Sapru, Joseph Kohne, Heidi M. Weeks, Martha A.Q. Curley, Michael A. Matthay, Michael W. Quasney, Scot T. Bateman, M. D. Berg, Santiago Borasino, G. Kris Bysani, Allison S. Cowl, Cindy Darnell Bowens, E. Vincent S. Faustino, Lori D. Fineman, A. J. Godshall, Ellie Hirshberg, Aileen L. Kirby, Gwenn E. McLaughlinShivanand Medar, Phineas P. Oren, James B. Schneider, Adam J. Schwarz, Thomas P. Shanley, Lauren R. Sorce, Edward J. Truemper, Michele A. Vander Heyden, Kim Wittmayer, Athena Zuppa, David Wypij

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Background: Elevated surfactant protein D (SP-D) is a relatively specific indicator of lung injury and is associated with both acute and chronic lung disease in adults and respiratory distress syndrome in premature infants. The relationship between plasma SP-D and lung injury in children with acute respiratory failure is unclear. Research Question: Is plasma SP-D associated with lung injury or outcome in children with acute respiratory failure? Study Design and Methods: This was a prospective cohort study in children 2 weeks to 17 years of age with acute respiratory failure who participated in the BALI multi-center study. Analyses were done using SP-D levels in plasma from the first sample taken on either the day of intubation or one of the following 2 days. SP-D level was measured by enzyme-linked immunosorbent assay. Results: Plasma samples from 350 patients were used in the analysis; 233 had pediatric ARDS (PARDS). SP-D levels varied across primary diagnoses (P < .001). Elevated SP-D levels were associated with severe PARDS after adjusting for age, pediatric risk of mortality III (PRISM-III), and primary diagnosis (OR = 1.02; CI = 1.01-1.04; P = .011). Multivariable analyses also indicated that elevated SP-D levels were associated with death (OR = 1.02; CI = 1.01-1.04; P = .004), duration of mechanical ventilation (P = .012), PICU length of stay (P = .019), and highest oxygenation index (P = .040). SP-D levels also correlated with age (rs = 0.16, P = .002). Interpretation: Elevated plasma SP-D levels are associated with severe PARDS and poor outcomes in children with acute respiratory failure. Future studies will determine whether SP-D can be used to predict the degree of lung injury or response to treatment and whether SP-D is useful in identifying PARDS endotypes.

Original languageEnglish (US)
Pages (from-to)1027-1035
Number of pages9
Issue number3
StatePublished - Sep 2020


  • ARDS
  • biomarker
  • critical illness
  • length of mechanical ventilation
  • mortality
  • outcome
  • pediatric ARDS
  • pediatrics
  • surfactant

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine


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