Effect of Respiratory Phenotype on Extrapulmonary Organ Dysfunction in Patients with ARDS: A Multicenter Study
Abstract
Abstract Background: The heterogeneity of acute respiratory distress syndrome (ARDS) extends beyond the lungs, with mortality driven primarily by extrapulmonary organ dysfunction rather than refractory hypoxemia. While individual respiratory parameters have been linked to extrapulmonary injury, their combined influence remains underexplored. This study aimed to identify respiratory phenotypes based on multiple parameters and examine their associations with extrapulmonary organ dysfunction. Methods: We conducted a multidatabase study based on the Chinese Database in Intensive Care (CDIC) and the ALVEOLI trial, focusing on patients with ARDS who underwent invasive mechanical ventilation. Latent profile analysis (LPA) and Consensus k -means clustering were applied to derive ARDS respiratory phenotypes on the basis of eight respiratory parameters. Extrapulmonary organ dysfunction during the first seven days was assessed, and linear mixed-effects models were used to compare the severity and temporal evolution of SOFA scores across respiratory phenotypes. Findings: A total of 769 patients with ARDS included in the CDIC were enrolled, and a three-class LPA model with optimal fit was identified: Class 1 (n=137, 17.9%) exhibited the highest PaO 2 /FiO 2 , lowest ventilatory ratio, and lowest 28-day mortality rate. Class 2 (n=67, 8.7%) presented the highest driving pressure, mechanical power, minute ventilation, ventilatory ratio, and PaCO 2 , along with the lowest PaO 2 /FiO 2 and…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 769 participants or records.
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