Research Article Impact of Serum Biomarkers and Clinical Factors on Intensive Care Unit Mortality and 6-Month Outcome in Relatively Healthy Patients with Severe Pneumonia and Acute Respiratory Distress Syndrome Chia-Cheng Tseng, 1,2 Wen-Feng Fang, 1,2,3 Sum-Yee Leung, 1,2 Hung-Chen Chen, 1 Ya-Chun Chang, 1 Chin-Chou Wang, 1,2,3 Huang-Chih Chang, 1,2 and Meng-Chih Lin 1,2,3 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan 2 Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi 813, Taiwan 3 Department of Respiratory herapy, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan Correspondence should be addressed to Meng-Chih Lin; linmengchih@hotmail.com Received 30 December 2013; Accepted 29 January 2014; Published 3 March 2014 Academic Editor: Vincent Sapin Copyright © 2014 Chia-Cheng Tseng et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objectives. his study aimed to identify the independent biomarkers and clinical factors that could predict ICU mortality and 6- month outcomes in relatively healthy patients with severe pneumonia and acute respiratory distress syndrome (ARDS). Patients and Methods. We prospectively enrolled patients with severe pneumonia-related ARDS that required mechanical ventilation. Patients were excluded if they were unable to take care of themselves. Several biomarkers and clinical factors were evaluated prospectively on day 1 and day 3 ater ICU admission. All biomarkers and clinical factors were collected for analysis. Results. 56 patients were enrolled in this study. We determined that the initial appropriate antibiotics use was an independent clinical factor and day 1 high-mobility group protein B1 (HMGB1) concentration was an independent biomarker for ICU mortality. Interestingly, we also found that a low day 1 albumin level was an independent biomarker for predicting patient life dependence 6 months ater a pneumonia event. Conclusion. Patients with severe pneumonia and ARDS requiring mechanical ventilation experience high rates of ICU mortality or disability, even if they were quite healthy before. Initial appropriate antibiotics use and day 1 level of HMGB1 were independent factors for predicting ICU mortality. Day 1 albumin level was predictive of 6-month patient life dependence. 1. Introduction Pneumonia is associated with a high morbidity and mortality rate throughout the world [1]. Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are important denouements of severe pneumonia and are associated with high mortality rates [2, 3] despite recent improvement in prognosis [4–6]. Sepsis (both from pulmonary and extrapul- monary origin) is a leading etiology of ALI/ARDS, and lung infection may account for up to 50% of ARDS cases [3, 7]. Although patients with severe pneumonia and ARDS can survive, survivors also frequently experience major long- term morbidities that impair their pulmonary, neuromuscu- lar, physical, cognitive, and psychological function. In turn, these impairments afect the survivors’ overall quality of life (QOL) [8, 9]. Previous studies also suggested that long- term survival is unafected by ARDS status; however, ARDS severely afects QOL, functional independence, and cognitive function [10–12]. In relatively healthy patients bearing few underlying diseases, severe pneumonia with ARDS status Hindawi Publishing Corporation Disease Markers Volume 2014, Article ID 804654, 9 pages http://dx.doi.org/10.1155/2014/804654