SynthesisThorax2021
Attributable mortality of acute respiratory distress syndrome: a systematic review, meta-analysis and survival analysis using targeted minimum loss-based estimation.
Synthesis in Thorax, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
19 citing papers in PubMed, 4 syntheses or guidelines pooled it, 40 citations in OpenAlex.
- Effect of driving pressure-limiting strategies on outcomes of patients with ARDS: a meta-analysis of randomized controlled trials.Critical care (London, England) · 2026Pooled it
- Association between thrombocytopenia and development of acute respiratory distress syndrome.Respiratory research · 2026Pooled it
- Efficacy and safety of mesenchymal stem/stromal cells and their derived extracellular vesicles for acute respiratory distress syndrome: a systematic review and meta-analysis.Stem cell research & therapy · 2025Pooled it
- Pooled it
- Baseline plasma IL-18 may predict simvastatin treatment response in patients with ARDS: a secondary analysis of the HARP-2 randomised clinical trial.Critical care (London, England) · 2022Trial
- Clinical Phenotyping in Acute Respiratory Distress Syndrome: Steps Towards Personalized Medicine.Journal of clinical medicine · 2025Article
- How sighing regulates pulmonary surfactant structure and its role in breathing mechanics.Science advances · 2025Article
- Lung-targeting lipid nanoparticle-mediated sparstolonin B delivery improves acute lung injury.Biomaterials science · 2025Article
- Optimizing Mechanical Ventilation Strategies in ARDS: The Role of Driving Pressure and Low Tidal Volume Ventilation.Critical care research and practice · 2025Review
- The Protective Effects of Sivelestat Sodium on the Basis of Corticosteroid Therapy in Patients With Moderate-to-Severe Acute Respiratory Distress Syndrome.Emergency medicine international · 2025Article
- Early Mortality in Clinical Trials of Acute Respiratory Distress Syndrome.American journal of respiratory and critical care medicine · 2024Article
- Attributable mortality of ARDS among critically ill patients with sepsis: a multicenter, retrospective cohort study.BMC pulmonary medicine · 2024Article
- Identifying a hyperinflammatory subphenotype of ARDS associated with worse outcomes: may ferritin help?Thorax · 2024Article
- Causal inference using observational intensive care unit data: a scoping review and recommendations for future practice.NPJ digital medicine · 2023Article
- Review
- Observational
- Intubation Timing in COVID-19 Based on ROX Index and Association With Patient Outcomes.Respiratory care · 2022Article
- The ROCK-ezrin signaling pathway mediates LPS-induced cytokine production in pulmonary alveolar epithelial cells.Cell communication and signaling : CCS · 2022Article
- Rapidly improving acute respiratory distress syndrome in COVID-19: a multi-centre observational study.Respiratory research · 2022Observational
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
15 authors at 4 institutions in 3 countries.
Funding
Abstract
backgroundAlthough acute respiratory distress syndrome (ARDS) is associated with high mortality, its direct causal link with death is unclear. Clarifying this link is important to justify costly research on prevention of ARDS.
objectiveTo estimate the attributable mortality, if any, of ARDS.
designFirst, we performed a systematic review and meta-analysis of observational studies reporting mortality of critically ill patients with and without ARDS matched for underlying risk factor. Next, we conducted a survival analysis of prospectively collected patient-level data from subjects enrolled in three intensive care unit (ICU) cohorts to estimate the attributable mortality of critically ill septic patients with and without ARDS using a novel causal inference method.
resultsIn the meta-analysis, 44 studies (47 cohorts) involving 56 081 critically ill patients were included. Mortality was higher in patients with versus without ARDS (risk ratio 2.48, 95% CI 1.86 to 3.30; p<0.001) with a numerically stronger association between ARDS and mortality in trauma than sepsis. In the survival analysis of three ICU cohorts enrolling 1203 critically ill patients, 658 septic patients were included. After controlling for confounders, ARDS was found to increase the mortality rate by 15% (95% CI 3% to 26%; p=0.015). Significant increases in mortality were seen for severe (23%, 95% CI 3% to 44%; p=0.028) and moderate (16%, 95% CI 2% to 31%; p=0.031), but not for mild ARDS.
conclusionsARDS has a direct causal link with mortality. Our findings provide information about the extent to which continued funding of ARDS prevention trials has potential to impart survival benefit. PROSPERO REGISTRATION NUMBER: CRD42017078313.
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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.