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

Details

• Personal Author:
  Comfort AL ; Echevarria GC ; Girvin FG ; Kwon S ; Nolan A ; Prezant DJ ; Rom, William N. ; Schenck EJ ; Weiden MD
• Description:
  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. [Description provided by NIOSH]
• Subjects:
  Biomarkers Blood Case Reports Chronic Disease Cytotoxins Dust Emergency Responders Firefighters Immune System Lung Lung Diseases Occupational Exposure Occupational Health Particulate Matter Respiratory Function Tests Respiratory System Respiratory Tract Diseases Safety

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• Keywords:
  Blood-serum Blood-vessels Case-studies Cellular-reactions Chronic-inflammation Cytotoxicity Dust-exposure Emergency-responders Employee-exposure Fire-fighters Immune-reaction Lung-disorders Particulate-dust Pulmonary-disorders Pulmonary-function Pulmonary-function-tests Pulmonary-system-disorders Respiratory-system-disorders Thorax

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• ISSN:
  2044-6055
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Journal Article
• Place as Subject:
  New York ; OSHA Region 2
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  4
• Issue:
  9
• NIOSHTIC Number:
  nn:20045215
• Citation:
  BMJ Open 2014 Sep; 4(9):e005575
• Contact Point Address:
  Anna Nolan, Division of Pulmonary, Critical Care and Sleep, New York University, School of Medicine, New York, New York, USA
• Email:
  anna.nolan@med.nyu.edu
• Federal Fiscal Year:
  2014
• Performing Organization:
  New York City Fire Department
• Peer Reviewed:
  True
• Start Date:
  20040701
• Source Full Name:
  BMJ Open
• End Date:
  20110630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:17924de9a4ccf05d4209111ef9cfb2f1cf4f2ded302d7dff588fbc65e11b1df56802d04eae2cca830e74e59cabc9e4188ba56af2bd59815135bccc86b550c932
• Download URL:
  https://stacks.cdc.gov/view/cdc/200721/cdc_200721_DS1.pdf
• File Type:
  [PDF - 1.55 MB ]