Heterogeneous phenotypes of acute respiratory distress syndrome after major trauma. Ann Am Thorac Soc 2014 Jun;11(5):728-36
Date
04/10/2014Pubmed ID
24712298Pubmed Central ID
PMC4225810DOI
10.1513/AnnalsATS.201308-280OCScopus ID
2-s2.0-84903575388 (requires institutional sign-in at Scopus site) 79 CitationsAbstract
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.
Author List
Reilly JP, Bellamy S, Shashaty MG, Gallop R, Meyer NJ, Lanken PN, Kaplan S, Holena DN, May AK, Ware LB, Christie JDAuthor
Daniel N. Holena MD Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultCritical Illness
Female
Follow-Up Studies
Humans
Male
Middle Aged
Phenotype
Retrospective Studies
Thoracic Injuries
Trauma Severity Indices
Young Adult
