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July 23/30, 2003

Apoptosis and Renal Function in Patients With Acute Respiratory Distress Syndrome—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290(4):461-462. doi:10.1001/jama.290.4.461-a

To the Editor: Dr Imai and colleagues1 investigated the association between changes in plasma levels of soluble Fas ligand and changes in creatinine in patients with acute respiratory distress syndrome (ARDS). However, I disagree with their method of computing the magnitude and direction of correlation.

The plasma samples were obtained from patients with ARDS treated with either conventional strategy (control group) or protective ventilatory strategy (lung protection group) in a previous randomized clinical trial.2 The authors reported that the mean plasma levels of soluble Fas ligand were significantly higher in the control group compared with the lung protection group at 2 different time points. This means that different treatment strategies changed the characteristics of soluble Fas ligand. In addition, the authors illustrated the association between changes in plasma levels of soluble Fas ligand and changes in levels of creatinine. The authors' figure indicates that the control group had a positive association, but that the lung protection group had a negative relationship. As a consequence, the correlation coefficient estimated from combining these 2 unique groups is apparently incorrect. The authors should have assessed and reported the relationship in the control group and the lung protection group separately.