ArticleIntensive care medicine2025
Temporal stability of phenotypes of acute respiratory distress syndrome: clinical implications for early corticosteroid therapy and mortality.
Article in Intensive care medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07511582 (Efficacy, Safety, and Tolerability of Methylprednisolone in Critically Ill Patients With the Hyperinflammatory Phenotype), which is not on this map. Cited by 33 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.
Efficacy, Safety, and Tolerability of Methylprednisolone in Critically Ill Patients With the Hyperinflammatory Phenotype: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Phase II Trial
Who cites it
33 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Sodium bicarbonate therapy in severe metabolic acidemia: an individual patient data meta-analysis of the BICAR-ICU and BICAR-ICU2 trials.Critical care (London, England) · 2026Pooled it
- Identifying effect modifiers of corticosteroids in acute respiratory distress syndrome: a meta-regression analysis of randomized controlled trials.BMC pulmonary medicine · 2026Pooled it
- Analysis of the pulmonary microbiome in ARDS patients using bronchoalveolar lavage fluid metagenomic next-generation sequencing: a retrospective observational study.Journal of intensive care · 2026Article
- Corticosteroids in ARDS: old controversies, new insights, and future directions.Intensive care medicine · 2026Review
- Inflammatory Subphenotypes for Fluid Management in Acute Respiratory Distress Syndrome: A Subgroup-Level Signal, not an Individual Prescription.Critical care explorations · 2026Article
- Postoperative ARDS: distinct etiologies, distinct priorities.Intensive care medicine · 2026Article
- Characterizing Cardiovascular Function In The Inflammatory Subphenotypes of Acute Respiratory Distress Syndrome.Critical care explorations · 2026Article
- Balancing lung and brain: physiological strategies for ARDS management in acute brain injury.Intensive care medicine · 2026Review
- The Acute Respiratory Distress Syndrome (ARDS): epidemiology, etiology, molecular mechanisms, diagnosis and therapeutic strategies.Molecular biomedicine · 2026Review
- Acute hypoxemic respiratory failure: from static severity to trajectory-based phenotyping.Intensive care medicine · 2026Article
- From physiological innovation to clinical precision: defining the right target for diaphragm neurostimulation.Journal of thoracic disease · 2026Article
- Reproducible clinical archetypes in acute respiratory failure: a multi-cohort trajectory analysis.Intensive care medicine · 2026Article
- The role of hemoadsorption in septic shock: toward a personalized approach.Critical care (London, England) · 2026Review
- Is postoperative ARDS different from medical ARDS?Critical care (London, England) · 2026Article
- ARDS and corticosteroids: beyond COVID-19.Pneumonia (Nathan Qld.) · 2026Review
- ERS Congress 2025: highlights from the Respiratory Intensive Care Assembly.ERJ open research · 2026Article
- Morphological subphenotypes in acute pancreatitis-related ARDS: limitations, extensions, and research priorities.Critical care (London, England) · 2026Article
- What is the meaning of a complication? Toward causal understanding in ARDS.Critical care (London, England) · 2026Article
- Computed tomography in ARDS, from morphological insights to AI-powered multi-modal analysis: a narrative review.Journal of intensive care · 2026Review
- Risk heterogeneity within hypoinflammatory acute respiratory failure: continuous probabilities identify high-risk patients masked by binary classification.Intensive care medicine · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
14 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeInflammatory phenotypes of acute respiratory distress syndrome (ARDS) can predict patient outcomes and potentially response to treatment. The aim was to assess whether inflammatory phenotypes can be characterized over time using clinical surrogate data and used to guide therapy with corticosteroids.
methodsIndividual patient data and biomarkers from six multicenter randomized controlled trials (development, n = 1207; validation, n = 2751) were analyzed to establish an open-source AI Clinical Classifier ( https://bostonmontpelliercare.shinyapps.io/AIClarity ) for inflammatory phenotypes of ARDS using routine clinical data. Then, patients from a retrospective cohort (investigation, n = 5578) underwent classification from baseline to day 30. A discrete-time Bayesian Markov model assessed temporal stability at 3-day intervals. A target trial emulation and longitudinal logistic regression assessed corticosteroid effect on 30-day mortality depending on phenotype.
resultsThe AI Clinical Classifier identified 2169 (39%) hyperinflammatory and 3409 (61%) hypoinflammatory patients. 1053 (49%) and 826 (24%) patients died within 30 days, respectively (p < 0.001). Over 30 days, 49%(1072/2169) of hyperinflammatory patients at baseline transitioned to hypoinflammatory, and 7%(229/3409) of hypoinflammatory patients at baseline transitioned to hyperinflammatory (p < 0.001). Phenotypes predicted response to corticosteroids, with lower mortality in hyperinflammatory patients (IPW-weighted hazard ratio [HR]: 0.81 [0.67-0.98], p = 0.033), and higher mortality in hypoinflammatory patients (IPW-weighted HR: 1.26 [1.06-1.50], p = 0.009). At day 3, a positive response to corticosteroids only persisted among patients who remained hyperinflammatory (adjusted odds ratio = 0.51, 95% CI 0.32-0.80, p = 0.004).
conclusionCharacterization of inflammatory ARDS phenotypes using clinical surrogate data allows physicians to monitor patients throughout the course of the disease and guide clinical treatment. Corticosteroids may be beneficial in hyperinflammatory ARDS and harmful in hypoinflammatory 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.