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Rapidly improving ARDS differs clinically and biologically from persistent ARDS
Patricia L Valda Toro1,2, Andrew Willmore3, Nelson E Wu3
1Department of Medicine, Division of Pulmonary and Critical Care, University of Pennsylvania, Philadelphia, PA, USA. Patricia.valdatoro@pennmedicine.upenn.edu.
Critical Care (London, England)
|April 22, 2024
Summary
Rapidly improving acute respiratory distress syndrome (RIARDS) is a subgroup of ARDS with better outcomes. RIARDS patients show lower inflammatory markers and a hypoinflammatory phenotype, suggesting distinct disease characteristics.
Area of Science:
- Critical Care Medicine
- Pulmonology
- Immunology
Background:
- Acute Respiratory Distress Syndrome (ARDS) is a severe lung condition.
- A subgroup, Rapidly Improving ARDS (RIARDS), shows quick recovery.
- RIARDS' clinical and biological features, and link to ARDS phenotypes, are unclear.
Purpose of the Study:
- Define clinical and biological features of RIARDS.
- Investigate the association between RIARDS and ARDS inflammatory subphenotypes.
Main Methods:
- Analyzed data from 215 intubated ARDS patients.
- Defined RIARDS by improved oxygenation or unassisted breathing within 2-4 days.
- Measured plasma biomarkers and allocated ARDS phenotypes.
Main Results:
- RIARDS represented 21% of ARDS cases.
- RIARDS patients had lower hospital mortality (13% vs 57%) and more ICU-free days.
- RIARDS was linked to lower IL-6, IL-8, PAI-1 levels and a hypoinflammatory phenotype (78% vs 51%).
Conclusions:
- RIARDS is common and has a better clinical course.
- RIARDS is characterized by lower inflammation and a hypoinflammatory phenotype.
- Identifying RIARDS may enhance clinical trial design and patient stratification.
Keywords:
Acute respiratory distress syndromeHypoinflammatory and hyperinflammatory ARDS phenotypesPrecision medicinePrognostic and predictive enrichment of clinical trialsRapidly improving acute respiratory distress syndromeMore Related Videos
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