Chest
Original Research: Critical CareDistinct Molecular Phenotypes of Direct vs Indirect ARDS in Single-Center and Multicenter Studies
Section snippets
Single-Center Study
Patients were drawn from the Validation of Biomarkers in Acute Lung Injury Diagnosis (VALID) study, a prospective cohort of critically ill patients at Vanderbilt University Medical Center, a tertiary care medical center. The inclusion and exclusion criteria for VALID have been described previously and are summarized in e-Appendix 1. Patients were enrolled in VALID on ICU day 2.14 The study was approved by the Vanderbilt University Institutional Review Board (#051065).
Patients were followed for
Patient Characteristics
Table 1 compares the patient characteristics in the two cohorts, stratified by direct vs indirect ARDS. In the single-center cohort, there were no significant differences in demographics between patients with direct and indirect ARDS; however, there were significant differences in severity of illness, with higher proportions of patients with indirect ARDS receiving vasopressors. Likewise, there was a trend toward higher APACHE II scores in indirect ARDS. Although the Pao2/Fio2 ratio was lower
Acknowledgments
Author contributions: C. S. C. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. C. S. C. and L. B. W. contributed to the study design, data cleaning and analysis, data interpretation, drafting and revision of the manuscript, and final approval of the manuscript; D. R. J. and K. N. K. contributed to the data collection and cleaning, data interpretation, and critical revision and final approval of the
References (38)
- et al.
Prognostic and pathogenetic value of combining clinical and biochemical indices in patients with acute lung injury
Chest
(2010) - et al.
Comparison of the Spo2/Fio2 ratio and the Pao2/Fio2 ratio in patients with acute lung injury or ARDS
Chest
(2007) - et al.
The circulating glycosaminoglycan signature of respiratory failure in critically ill adults
J Biol Chem
(2014) - et al.
Elevated levels of the receptor for advanced glycation end products, a marker of alveolar epithelial type I cell injury, predict impaired alveolar fluid clearance in isolated perfused human lungs
Chest
(2009) - et al.
Clara cell protein (CC16), a marker of lung epithelial injury, is decreased in plasma and pulmonary edema fluid from patients with acute lung injury
Chest
(2009) - et al.
The acute respiratory distress syndrome
N Engl J Med
(2000) - et al.
Pulmonary and extrapulmonary acute lung injury: inflammatory and ultrastructural analyses
J Appl Physiol (1985)
(2005) - et al.
Pulmonary and extrapulmonary acute respiratory distress syndrome are different
Eur Respir J
(2003) - et al.
The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination
Am J Respir Crit Care Med
(1994) - et al.
Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease. Different syndromes?
Am J Respir Crit Care Med
(1998)
Influence of direct and indirect etiology on acute outcome and 6-month functional recovery in acute respiratory distress syndrome
Crit Care Med
Acute respiratory distress syndrome: the Berlin Definition
JAMA
Randomized, placebo-controlled clinical trial of an aerosolized β-agonist for treatment of acute lung injury
Am J Respir Crit Care Med
Plasma receptor for advanced glycation end products and clinical outcomes in acute lung injury
Thorax
Plasma angiopoietin-2 in clinical acute lung injury: prognostic and pathogenetic significance
Crit Care Med
Plasma biomarkers of lung epithelial versus endothelial injury differentiate direct from indirect acute lung injury [abstract]
Am J Respir Crit Care Med
Biomarkers of lung epithelial and endothelial injury differentiate between direct and indirect ARDS in single and multi-center studies [abstract]
Am J Respir Crit Care Med
Biomarkers of lung epithelial injury and inflammation distinguish severe sepsis patients with acute respiratory distress syndrome
Crit Care
Efficacy of low tidal volume ventilation in patients with different clinical risk factors for acute lung injury and the acute respiratory distress syndrome
Am J Respir Crit Care Med
Cited by (272)
Acute Respiratory Distress Syndrome: Definition, Diagnosis, and Routine Management
2024, Critical Care ClinicsGlycyrrhizin mitigates acute lung injury by inhibiting the NLRP3 inflammasome in vitro and in vivo
2023, Journal of EthnopharmacologyPregnancy and Severe ARDS with COVID-19: Epidemiology, Diagnosis, Outcomes and Treatment
2023, Seminars in Fetal and Neonatal MedicineSignaling pathways and potential therapeutic targets in acute respiratory distress syndrome (ARDS)
2024, Respiratory ResearchTranslational medicine for acute lung injury
2024, Journal of Translational Medicine
Part of this article has been presented in abstract form at the American Thoracic Society International Conferences, May 17-22, 2013, Philadelphia, PA, and May 16-21, 2014, San Diego, CA.
FUNDING/SUPPORT: This work was supported by contracts with the National Heart, Lung, and Blood Institute (NHLBI) [NO1-HR-46046-64 and NO1-HR-16146-54]. Dr Calfee was supported by the National Institutes of Health (NIH) [HL090833 and HL110969]. Dr Janz was supported by the NIH [T32 HL087738]. Dr Kangelaris was supported by the NHLBI [1K23 HL116800-01]. Dr Matthay was supported by the NIH [HL51856]. Dr Ware was supported by the NIH [HL103836 and HL112656].
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.