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Prediction of long-term outcome subtypes in ARDS: first steps towards personalised medicine in critical care
  1. Nicola Latronico1,2,
  2. Cosetta Minelli3,
  3. Matthias Eikermann4,5
  1. 1Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
  2. 2Department of Anesthesia, Critical Care and Emergency, Brescia University Hospital, Brescia, Italy
  3. 3Population Health and Occupational Disease, National Heart and Lung Institute, Imperial College London, London, UK
  4. 4Department of Anesthesia, Critical and Pain Medicine, Beth Israel Deconness Medical Center, Boston, Massachusetts, USA
  5. 5Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Professor Nicola Latronico, Department of Anesthesia, Critical Care and Emergency, Brescia University Hospital, Brescia 25121, Italy; nicola.latronico{at}unibs.it

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In Thorax, Samuel Brown and colleagues present their result on early identification of physical, cognitive and mental health outcome subtypes in patients who survived acute respiratory distress syndrome (ARDS).1 Using data from the ARDSNet Long-Term Outcomes Study, the authors identified a group of 645 patients who had been studied with a comprehensive battery of validated health outcome instruments, which included measures of physical, cognitive and mental health (anxiety, depression and post-traumatic stress disorder), as well as quality of life status, obtained at 6-month follow-up. After splitting the data into derivation and validation datasets, the authors used a data mining approach, weighted network analysis, to identify and validate four outcome subphenotypes. They identified four subtypes: (1) mildly impaired physical and mental health status; (2) moderately impaired physical and mental health status; (3) severely impaired physical and moderately impaired mental health status; and (4) severely impaired physical and mental health status. In each of the four subtypes, one-third of patients suffered a significant decrease from baseline in their health state measured with the EQ-5D or SF36. Separation of outcome subtypes in relation to various instruments of physical and mental health assessment was good, while cognitive function evaluated with Mini-Mental State Examination did not differ significantly across subtypes. Cognitive outcomes remained unrelated to the subtypes defined by physical and mental health outcomes also when using a battery of more detailed cognitive tests available for a subset of patients. This multicentre study confirms that ARDS is associated with long-lasting disability after the resolution of the acute condition: fewer than half of patients were living at home independently at 6 months compared with 91% at baseline. Physical and mental impairments were both severe in one quarter of them, who were mainly female, current smokers …

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