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Enlarged pulmonary artery is predicted by vascular injury biomarkers and is associated with WTC-lung injury in exposed fire fighters: a case-control study.

Authors
Schenck-EJ; Echevarria-GC; Girvin-FG; Kwon-S; Comfort-AL; Rom-WN; Prezant-DJ; Weiden-MD; Nolan-A
Source
BMJ Open 2014 Sep; 4(9):e005575
NIOSHTIC No.
20045215
Abstract
OBJECTIVES: We hypothesise that there is an association between an elevated pulmonary artery/aorta (PA/A) and World Trade Center-Lung Injury (WTC-LI). We assessed if serum vascular disease biomarkers were predictive of an elevated PA/A. DESIGN: Retrospective case-cohort analysis of thoracic CT scans of WTC-exposed firefighters who were symptomatic between 9/12/2001 and 3/10/2008. Quantification of vascular-associated biomarkers from serum collected within 200 days of exposure. SETTING: Urban tertiary care centre and occupational healthcare centre. PARTICIPANTS: Male never-smoking firefighters with accurate pre-9/11 forced expiratory volume in 1 s (FEV1) =75%, serum sampled =200 days of exposure was the baseline cohort (n=801). A subcohort (n=97) with available CT scans and serum biomarkers was identified. WTC-LI was defined as FEV1=77% at the subspecialty pulmonary evaluation (n=34) and compared with controls (n=63) to determine the associated PA/A ratio. The subcohort was restratified based on PA/A=0.92 (n=38) and PA/A<0.92(n=59) to determine serum vascular biomarkers that were predictive of this vasculopathy. OUTCOME MEASURES: The primary outcome of this study was to identify a PA/A ratio in a cohort of individuals exposed to WTC dust that was associated with WTC-LI. The secondary outcome was to identify serum biomarkers predictive of the PA/A ratio using logistic regression. RESULTS: PA/A=0.92 was associated with WTC-LI, OR of 4.02 (95% CI 1.21 to 13.41; p=0.023) when adjusted for exposure, body mass index and age at CT. Elevated macrophage derived chemokine and soluble endothelial selectin were predictive of PA/A=0.92, (OR, 95% CI 2.08, 1.05 to 4.11, p=0.036; 1.33, 1.06 to 1.68, p=0.016, respectively), while the increased total plasminogen activator inhibitor 1 was predictive of not having PA/A=0.92 (OR 0.88, 0.79 to 0.98; p=0.024). CONCLUSIONS: Elevated PA/A was associated with WTC-LI. Development of an elevated PA/A was predicted by biomarkers of vascular disease found in serum drawn within 6 months of WTC exposure. Increased PA/A is a potentially useful non-invasive biomarker of WTC-LI and warrants further study.
Keywords
Fire-fighters; Emergency-responders; Respiratory-system-disorders; Pulmonary-system-disorders; Lung-disorders; Dust-exposure; Employee-exposure; Particulate-dust; Immune-reaction; Cytotoxicity; Chronic-inflammation; Case-studies; Biomarkers; Blood-serum; Blood-vessels; Thorax; Pulmonary-disorders; Pulmonary-function; Pulmonary-function-tests; Cellular-reactions
Contact
Anna Nolan, Division of Pulmonary, Critical Care and Sleep, New York University, School of Medicine, New York, New York, USA
Publication Date
20140929
Document Type
Journal Article
Email Address
anna.nolan@med.nyu.edu
Funding Type
Cooperative Agreement
Fiscal Year
2014
NTIS Accession No.
NTIS Price
Identifying No.
Cooperative-Agreement-Number-U10-OH-008243; Cooperative-Agreement-Number-U10-OH-008242; M102014
Issue of Publication
9
ISSN
2044-6055
Source Name
BMJ Open
State
NY
Performing Organization
New York City Fire Department
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