Heterogeneous phenotypes of acute respiratory distress syndrome after major trauma

Ann Am Thorac Soc. 2014 Jun;11(5):728-36. doi: 10.1513/AnnalsATS.201308-280OC.


Rationale: Acute respiratory distress syndrome (ARDS) is a heterogeneous syndrome that can develop at various times after major trauma.

Objectives: To identify and characterize distinct phenotypes of ARDS after trauma, based on timing of syndrome onset.

Methods: Latent class analyses were used to identify patterns of ARDS onset in a cohort of critically ill trauma patients. Identified patterns were tested for associations with known ARDS risk factors and associations were externally validated at a separate institution. Eleven plasma biomarkers representing pathophysiologic domains were compared between identified patterns in the validation cohort.

Measurements and main results: Three patterns of ARDS were identified; class I (52%) early onset on Day 1 or 2, class II (40%) onset on Days 3 and 4, and class III (8%) later onset on Days 4 and 5. Early-onset ARDS was associated with higher Abbreviated Injury Scale scores for the thorax (P < 0.001), lower lowest systolic blood pressure before intensive care unit admission (P = 0.003), and a greater red blood cell transfusion requirement during resuscitation (P = 0.030). In the external validation cohort, early-onset ARDS was also associated with a higher Abbreviated Injury Scale score for the thorax (P = 0.001) and a lower lowest systolic blood pressure before intensive care unit enrollment (P = 0.006). In addition, the early-onset phenotype demonstrated higher plasma levels of soluble receptor for advanced glycation end-products and angiopoietin-2.

Conclusions: Degree of hemorrhagic shock and severity of thoracic trauma are associated with an early-onset phenotype of ARDS after major trauma. Lung injury biomarkers suggest a dominant alveolar-capillary barrier injury pattern in this phenotype.

Keywords: acute respiratory distress syndrome; critical illness; hemorrhagic shock; phenotype; trauma.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Critical Illness*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Phenotype
  • Respiratory Distress Syndrome / diagnosis
  • Respiratory Distress Syndrome / etiology
  • Respiratory Distress Syndrome / genetics*
  • Retrospective Studies
  • Thoracic Injuries / complications*
  • Thoracic Injuries / diagnosis
  • Trauma Severity Indices
  • Young Adult