[Research progress on extrapulmonary risk factors for sepsis-associated acute respiratory distress syndrome]

Sepsis is a state of uncontrolled systemic inflammation triggered by infection, characterized by multiple organ dysfunction resulting from dysregulated host immune responses. This pathological process involves not only the direct effects of pathogen invasion but also reflects a vicious cycle where infection triggers an inflammatory storm, leading to organ decompensation. During disease progression, acute respiratory distress syndrome (ARDS), as a typical complication in the terminal stage of sepsis, is closely associated with increased patient mortality and decreased long-term quality of life. Recent evidence indicates that, in addition to primary pulmonary injury, systemic pathological changes such as liver and kidney dysfunction, metabolic imbalance, and coagulation disorders may serve as important contributors to ARDS development through pathways including systemic inflammatory cascades and disruption of vascular endothelial integrity. Notably, the Sequential Organ Failure Assessment (SOFA) score, as a dynamic monitoring tool for sepsis, shows significant correlations between its parameter fluctuations and ARDS progression. However, comprehensive and in-depth research systems are currently lacking regarding the molecular interaction mechanisms, temporal association characteristics, and clinical predictive value between extrapulmonary organ injury and dynamic SOFA score evolution. Based on recent research advances, this article systematically elucidates the following key scientific questions: 1) The pathophysiological mechanisms underlying the transition from sepsis to ARDS; 2) The pathways through which systemic risk factors such as liver and kidney dysfunction act; 3) The strength of association between individual SOFA score components and ARDS development. By analyzing the temporal characteristics of multiple organ failure and the kinetic relationship with respiratory dysfunction, the research focuses on establishing a risk assessment system based on organ injury combination patterns, providing dual clinical guidance: 1) Individualized risk stratification based on organ injury characteristics; 2) Precision intervention strategies targeting specific pathological links. This theoretical framework will promote the transformation of ARDS prevention and treatment from pulmonary protection strategies to collaborative multi-organ management models, ultimately achieving individualized precision diagnosis and treatment for sepsis-associated ARDS.