Urine Hydrogen Peroxide During Adult Respiratory Distress Syndrome in Patients With and Without Sepsis

Background The lung injury in adult respiratory distress syndrome (ARDS) has been associated with increased expiratory hydrogen peroxide (H 2 O 2 ) concentrations. Furthermore, patients with sepsis and ARDS are reported to have greater serum scavenging of H 2 O 2 than patients with ARDS only. We hypothesized that the systemic presence of H 2 O 2 would be detectable in the urine of diese two groups of patients and that, in the case of ARDS sepsis, the relative contribution of each disease to the production this analyte would be discernible. Accordingly, we used an m vitro radioisotope assay to follow the weekly course of urine H 2 O 2 levels in ARDS patients with and without sepsis, and in samples from control non-ARDS patients with sepsis with indwelling urinary catheters and in samples provided by healthy volunteers. Methods Thirty patients with ARDS were included in the study; 23 had sepsis and 7 were sepsis free. An indwelling catheter was used to collect urine from each patient over a 24-h period, first within 48 h of ICU admission and then every seventh day over the course of their illness. Urine H 2 O 2 was measured by competitive decarboxylation of 1 14 C-alpha-ketoghitarie add by H 2 O 2 . Urine samples were provided by 20 healthy volunteers while, in 10 non-ARDS patients with sepsis, urine was collected over one 24-h period following a 5-day minimum with an indwelling urinary catheter. Results Urine H 2 O 2 concentration in healthy control subjects (88 ± 4 μmol/L) and non-ARDS patients with, urinary catheters (96 ± 5 μmol/L) was not significantly different During the first 48 h in the ICU, urine H 2 O 2 in patients with ARDS only (295 ± 29 µmol/L) was significantly lower (p 2 O 2 of the patients with ARDS and sepsis who did not survive (427 ± 19 μmol/L; n = 7) was significantly higher than that in patients who survived sepsis (352 ± 14 μmol/L; n = 15). Thereafter, the lung injury scores and urine H 2 O 2 levels of the nonsurvivor ARDS-sepsis group remained significantly higher compared with the other two groups. At lung injury scores of 3 and 2, regardless of days in ICU, the patients with ARDS only had significantly lower urine H 2 O 2 (266 ± 30 µmol/L and 167 ± 24 μmol/L, respectively) compared with the survivor ARDS-sepsis group (376 ± 19 μmol/L and 250 ± µmol/L). When the patients with ARDS (both ARDS only and with sepsis) recovered, their urine H 2 O 2 concentration did not differ from the control groups (healthy donors and patients without ARDS). Conclusion Lung injury scores did not differentiate patients with ARDS and sepsis from patients with ARDS only during the first 10 days in the ICU; however, urine H 2 O 2 levels were significantly greater in the patients with ARDS and sepsis. Moreover, despite no initial difference in lung injury, patients who did not survive ARDS and sepsis had consistently greater urine H 2 O 2 concentration than patients who survived sepsis. The urine H 2 O 2 level in the ARDS-only group was about 70 percent of the level in the survivor ARDS and sepsis group, suggesting that ARDS alone is the major contributor to the H 2 O 2 oxidant processes during combined ARDS and sepsis. Furthermore, these studies demonstrate that urine H 2 O 2 may be a useful analyte to differentiate the severity of oxidant processes in patients with ARDS and sepsis albeit the prognosis appears to be survival or nonsurvival.