ARDS of early or late onset: does it make a difference?

Area of Science:

• Critical Care Medicine
• Pulmonology
• Epidemiology

Background:

• Clinical trials assessing therapies for acute respiratory distress syndrome (ARDS) may face lead-time bias due to differing outcomes between early- and late-onset conditions.
• This study investigates if late-onset ARDS is associated with worse outcomes compared to early-onset ARDS.

Purpose of the Study:

• To determine if the timing of Acute Respiratory Distress Syndrome (ARDS) onset (early vs. late) influences patient outcomes.
• To assess potential lead-time bias in clinical trials for ARDS therapies.

Main Methods:

• Utilized data from the Sepsis Occurrence in Acutely Ill Patients (SOAP) study, a multicenter observational study across 198 European ICUs.
• Defined early/late onset Acute Lung Injury (ALI)/ARDS as occurring within/after 48 hours of ICU admission.
• Included 3,147 adult patients admitted to ICUs, excluding those for uncomplicated postoperative surveillance.

Main Results:

• Out of 3,147 patients, 393 (12.5%) had ALI/ARDS, with 254 early-onset and 139 late-onset.
• Early-onset ALI/ARDS patients presented with higher severity scores (SAPS II, SOFA) on admission.
• Late-onset ALI/ARDS patients had significantly longer ICU and hospital lengths of stay, though mortality rates were not significantly different and potentially lower.

Conclusions:

• No significant difference in mortality rates was observed between early- and late-onset ARDS.
• Patients with late-onset ARDS experienced prolonged ICU and hospital stays compared to those with early-onset ARDS.