Observational studyThorax2017
Identification and validation of distinct biological phenotypes in patients with acute respiratory distress syndrome by cluster analysis.
Observational study in Thorax, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07281911 (Characterization of Early Biological and Mechanical Profiles in Sepsis-Associated ARDS for Studying Compartmentalization), which is not on this map. Cited by 187 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Characterization of Early Biological and Mechanical Profiles in Sepsis-Associated ARDS for Studying Compartmentalization (Serial Bronchoalveolar Lavage and Plasma Biomarkers) to Identify Inflammatory and Hybrid Subphenotypes
Who cites it
187 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Pooled it
- Between-trial heterogeneity in ARDS research.Intensive care medicine · 2021Pooled it
- Early differential protein expression in blood and bronchoalveolar fluid among ARDS phenotypes.Scientific reports · 2026Trial
- Immunomodulation and endothelial barrier protection mediate the association between oral imatinib and mortality in hospitalised COVID-19 patients.The European respiratory journal · 2022Trial
- Longitudinal phenotypes in patients with acute respiratory distress syndrome: a multi-database study.Critical care (London, England) · 2022Trial
- The prognostic value of early measures of the ventilatory ratio in the ARDS ROSE trial.Critical care (London, England) · 2022Trial
- The Activin/FLRG Pathway Associates with Poor COVID-19 Outcomes in Hospitalized Patients.Molecular and cellular biology · 2022Trial
- Individualized PEEP to optimise respiratory mechanics during abdominal surgery: a pilot randomised controlled trial.British journal of anaesthesia · 2020Trial
- Latent class analysis of ARDS subphenotypes: a secondary analysis of the statins for acutely injured lungs from sepsis (SAILS) study.Intensive care medicine · 2018Trial
- Presenting Characteristics Associated With Outcome in Children With Severe Traumatic Brain Injury: A Secondary Analysis From a Randomized, Controlled Trial of Therapeutic Hypothermia.Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2018Trial
- Imaging in ARDS: physiology-guided decisions in the AI era.Intensive care medicine · 2026Article
- The molecular ICU: a primer on omics, informatics and the future of precision critical care.Critical care (London, England) · 2026Review
- Diffuse alveolar damage, acute respiratory distress syndrome (ARDS), and non-cardiogenic pulmonary edema. Part 1: ARDS endotypes, including systemic inflammatory response syndrome and sepsis, with dog and cat examples.Journal of veterinary diagnostic investigation : official publication of the American Association of Veterinary Laboratory Diagnosticians, Inc · 2026Review
- Cytokine storm in acute respiratory distress syndrome.Journal of intensive medicine · 2026Review
- A cumulative-morbidity plasma proteomic architecture of critical-illness susceptibility: a UK biobank proteome-wide study of critical-care exposure, in-hospital death, and sex-specific signals.Journal of intensive care · 2026Article
- Clinical models for predicting 30-day mortality in ARDS: A focus on ventilatory ratio-defined subgroups.Journal of intensive medicine · 2026Article
- Inflammatory Biomarkers as Mediators of the Effect Between High-Dose Corticosteroid Therapy and Mortality in COVID-19-Related ARDS: A Causal Mediation Analysis.Immunity, inflammation and disease · 2026Article
- Biomarker-guided use of corticosteroids in pneumonia.Pneumonia (Nathan Qld.) · 2026Review
- Advances in Imaging and Physiology-Guided Personalized Care in Acute Respiratory Distress Syndrome.Medicina (Kaunas, Lithuania) · 2026Review
- Alveolar Immune Profiling Identifies Distinct Subphenotypes of Acute Respiratory Failure.medRxiv : the preprint server for health sciences · 2026Article
127 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
15 authors.
Funding
Abstract
rationaleWe hypothesised that patients with acute respiratory distress syndrome (ARDS) can be clustered based on concentrations of plasma biomarkers and that the thereby identified biological phenotypes are associated with mortality.
methodsConsecutive patients with ARDS were included in this prospective observational cohort study. Cluster analysis of 20 biomarkers of inflammation, coagulation and endothelial activation provided the phenotypes in a training cohort, not taking any outcome data into account. Logistic regression with backward selection was used to select the most predictive biomarkers, and these predicted phenotypes were validated in a separate cohort. Multivariable logistic regression was used to quantify the independent association with mortality.
resultsTwo phenotypes were identified in 454 patients, which we named 'uninflamed' (N=218) and 'reactive' (N=236). A selection of four biomarkers (interleukin-6, interferon gamma, angiopoietin 1/2 and plasminogen activator inhibitor-1) could be used to accurately predict the phenotype in the training cohort (area under the receiver operating characteristics curve: 0.98, 95% CI 0.97 to 0.99). Mortality rates were 15.6% and 36.4% (p<0.001) in the training cohort and 13.6% and 37.5% (p<0.001) in the validation cohort (N=207). The 'reactive phenotype' was independent from confounders associated with intensive care unit mortality (training cohort: OR 1.13, 95% CI 1.04 to 1.23; validation cohort: OR 1.18, 95% CI 1.06 to 1.31).
conclusionsPatients with ARDS can be clustered into two biological phenotypes, with different mortality rates. Four biomarkers can be used to predict the phenotype with high accuracy. The phenotypes were very similar to those found in cohorts derived from randomised controlled trials, and these results may improve patient selection for future clinical trials targeting host response in patients with ARDS.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.