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Editorial
Divide and conquer: identifying acute respiratory distress syndrome subphenotypes
  1. Manu Shankar-Hari1,2,
  2. Daniel F McAuley3,4
  1. 1Department of Critical Care Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
  2. 2Division of Infection and Immunity, King’s College London, London, London, UK
  3. 3Centre for Experimental Medicine, Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University of Belfast, Belfast, Northern Ireland
  4. 4Regional Intensive Care Unit, Royal Victoria Hospital, Belfast, Northern Ireland
  1. Correspondence to Professor Daniel F McAuley, Centre for Experimental Medicine, Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University of Belfast, Belfast BT7 1NN, UK; d.f.mcauley{at}qub.ac.uk

https://doi.org/10.1136/thoraxjnl-2017-210422

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    The acute respiratory distress syndrome (ARDS) definition identifies patients with acute onset hypoxaemia and respiratory failure, who have bilateral opacities on chest radiograph that are not fully explained by cardiac failure or fluid overload.1 ARDS is a common illness that accounts for approximately 10% of critical care admissions and 20% of patients requiring mechanical ventilation.2 The hospital mortality in patients with ARDS remains high, increasing from approximately 35% for those with mild disease to 46% for those with severe ARDS.2 This high mortality has remained relatively unchanged in the last 20 years.3 To date, despite decades of research, there is no pharmacological treatment that can modify the underlying biological mechanisms implicated in ARDS and improve patient outcomes.4 Within ARDS populations, there is substantial biological and outcome heterogeneity, with observed differences in dominant pathogenic mechanisms, treatment responses and outcomes.5–7 Identifying ARDS subphenotypes based on pathogenic mechanisms that determine treatment responses irrespective of ARDS severity is defined as predictive enrichment.7 8 The identification of such ARDS subphenotypes will enable improved trial design in ARDS by selecting patients based on responder characteristics to therapeutic interventions, hopefully resulting in improved outcomes.6

    In Thorax, Bos et al report a cohort study in 700 ARDS patients, testing the hypothesis that ARDS subgroups exist due to differences in biological characteristics.9 In this retrospective analysis of a prospectively collected cohort, 20 biomarkers were …

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    Footnotes

    • Contributors MS-H wrote the first draft. MS-H and DFM critically revised the manuscript for important intellectual content and agreed on the final submitted version of the manuscript.

    • Funding MS-H is supported by the National Institute for Health Research Clinician Scientist Award (NIHR-CS-2016-16-011).

    • Disclaimer The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the UK National Institute for Health Research or the Department of Health.

    • Competing interests None declared.

    • Provenance and peer review Commissioned; externally peer reviewed.

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