Etiology-associated heterogeneity in acute respiratory distress syndrome: a retrospective cohort study
Abstract Background Heterogeneity in acute respiratory distress syndrome (ARDS) has led to many statistically negative clinical trials. Etiology is considered an important source of pathogenesis heterogeneity in ARDS but previous studies have usually adopted a dichotomous classification, such as pul...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-05-01
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| Series: | BMC Pulmonary Medicine |
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| Online Access: | https://doi.org/10.1186/s12890-021-01557-9 |
| _version_ | 1819015836233367552 |
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| author | Sheng-Yuan Ruan Chun-Ta Huang Ying-Chun Chien Chun-Kai Huang Jung-Yien Chien Lu-Cheng Kuo Ping-Hung Kuo Shih-Chi Ku Huey-Dong Wu |
| author_facet | Sheng-Yuan Ruan Chun-Ta Huang Ying-Chun Chien Chun-Kai Huang Jung-Yien Chien Lu-Cheng Kuo Ping-Hung Kuo Shih-Chi Ku Huey-Dong Wu |
| author_sort | Sheng-Yuan Ruan |
| collection | DOAJ |
| description | Abstract Background Heterogeneity in acute respiratory distress syndrome (ARDS) has led to many statistically negative clinical trials. Etiology is considered an important source of pathogenesis heterogeneity in ARDS but previous studies have usually adopted a dichotomous classification, such as pulmonary versus extrapulmonary ARDS, to evaluate it. Etiology-associated heterogeneity in ARDS remains poorly described. Methods In this retrospective cohort study, we described etiology-associated heterogeneity in gas exchange abnormality (PaO2/FiO2 [P/F] and ventilatory ratios), hemodynamic instability, non-pulmonary organ dysfunction as measured by the Sequential Organ Failure Assessment (SOFA) score, biomarkers of inflammation and coagulation, and 30-day mortality. Linear regression was used to model the trajectory of P/F ratios over time. Wilcoxon rank-sum tests, Kruskal–Wallis rank tests and Chi-squared tests were used to compare between-etiology differences. Results From 1725 mechanically ventilated patients in the ICU, we identified 258 (15%) with ARDS. Pneumonia (48.4%) and non-pulmonary sepsis (11.6%) were the two leading causes of ARDS. Compared with pneumonia associated ARDS, extra-pulmonary sepsis associated ARDS had a greater P/F ratio recovery rate (difference = 13 mmHg/day, p = 0.01), more shock (48% versus 73%, p = 0.01), higher non-pulmonary SOFA scores (6 versus 9 points, p < 0.001), higher d-dimer levels (4.2 versus 9.7 mg/L, p = 0.02) and higher mortality (43% versus 67%, p = 0.02). In pneumonia associated ARDS, there was significant difference in proportion of shock (p = 0.005) between bacterial and non-bacterial pneumonia. Conclusion This study showed that there was remarkable etiology-associated heterogeneity in ARDS. Heterogeneity was also observed within pneumonia associated ARDS when bacterial pneumonia was compared with other non-bacterial pneumonia. Future studies on ARDS should consider reporting etiology-specific data and exploring possible effect modification associated with etiology. |
| first_indexed | 2024-12-21T02:38:04Z |
| format | Article |
| id | doaj.art-2c225976bb434e458b708780f0bba755 |
| institution | Directory Open Access Journal |
| issn | 1471-2466 |
| language | English |
| last_indexed | 2024-12-21T02:38:04Z |
| publishDate | 2021-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pulmonary Medicine |
| spelling | doaj.art-2c225976bb434e458b708780f0bba7552022-12-21T19:18:44ZengBMCBMC Pulmonary Medicine1471-24662021-05-012111910.1186/s12890-021-01557-9Etiology-associated heterogeneity in acute respiratory distress syndrome: a retrospective cohort studySheng-Yuan Ruan0Chun-Ta Huang1Ying-Chun Chien2Chun-Kai Huang3Jung-Yien Chien4Lu-Cheng Kuo5Ping-Hung Kuo6Shih-Chi Ku7Huey-Dong Wu8Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital and College of MedicineDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital and College of MedicineDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital and College of MedicineDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital and College of MedicineDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital and College of MedicineDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital and College of MedicineDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital and College of MedicineDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital and College of MedicineDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital and College of MedicineAbstract Background Heterogeneity in acute respiratory distress syndrome (ARDS) has led to many statistically negative clinical trials. Etiology is considered an important source of pathogenesis heterogeneity in ARDS but previous studies have usually adopted a dichotomous classification, such as pulmonary versus extrapulmonary ARDS, to evaluate it. Etiology-associated heterogeneity in ARDS remains poorly described. Methods In this retrospective cohort study, we described etiology-associated heterogeneity in gas exchange abnormality (PaO2/FiO2 [P/F] and ventilatory ratios), hemodynamic instability, non-pulmonary organ dysfunction as measured by the Sequential Organ Failure Assessment (SOFA) score, biomarkers of inflammation and coagulation, and 30-day mortality. Linear regression was used to model the trajectory of P/F ratios over time. Wilcoxon rank-sum tests, Kruskal–Wallis rank tests and Chi-squared tests were used to compare between-etiology differences. Results From 1725 mechanically ventilated patients in the ICU, we identified 258 (15%) with ARDS. Pneumonia (48.4%) and non-pulmonary sepsis (11.6%) were the two leading causes of ARDS. Compared with pneumonia associated ARDS, extra-pulmonary sepsis associated ARDS had a greater P/F ratio recovery rate (difference = 13 mmHg/day, p = 0.01), more shock (48% versus 73%, p = 0.01), higher non-pulmonary SOFA scores (6 versus 9 points, p < 0.001), higher d-dimer levels (4.2 versus 9.7 mg/L, p = 0.02) and higher mortality (43% versus 67%, p = 0.02). In pneumonia associated ARDS, there was significant difference in proportion of shock (p = 0.005) between bacterial and non-bacterial pneumonia. Conclusion This study showed that there was remarkable etiology-associated heterogeneity in ARDS. Heterogeneity was also observed within pneumonia associated ARDS when bacterial pneumonia was compared with other non-bacterial pneumonia. Future studies on ARDS should consider reporting etiology-specific data and exploring possible effect modification associated with etiology.https://doi.org/10.1186/s12890-021-01557-9Acute respiratory distress syndromeHeterogeneityPhenotypePneumoniaRespiratory failureSepsis |
| spellingShingle | Sheng-Yuan Ruan Chun-Ta Huang Ying-Chun Chien Chun-Kai Huang Jung-Yien Chien Lu-Cheng Kuo Ping-Hung Kuo Shih-Chi Ku Huey-Dong Wu Etiology-associated heterogeneity in acute respiratory distress syndrome: a retrospective cohort study BMC Pulmonary Medicine Acute respiratory distress syndrome Heterogeneity Phenotype Pneumonia Respiratory failure Sepsis |
| title | Etiology-associated heterogeneity in acute respiratory distress syndrome: a retrospective cohort study |
| title_full | Etiology-associated heterogeneity in acute respiratory distress syndrome: a retrospective cohort study |
| title_fullStr | Etiology-associated heterogeneity in acute respiratory distress syndrome: a retrospective cohort study |
| title_full_unstemmed | Etiology-associated heterogeneity in acute respiratory distress syndrome: a retrospective cohort study |
| title_short | Etiology-associated heterogeneity in acute respiratory distress syndrome: a retrospective cohort study |
| title_sort | etiology associated heterogeneity in acute respiratory distress syndrome a retrospective cohort study |
| topic | Acute respiratory distress syndrome Heterogeneity Phenotype Pneumonia Respiratory failure Sepsis |
| url | https://doi.org/10.1186/s12890-021-01557-9 |
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