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Understanding patient outcomes after acute respiratory distress syndrome: identifying subtypes of physical, cognitive and mental health outcomes
  1. Samuel M Brown1,2,3,
  2. Emily L Wilson1,2,
  3. Angela P Presson4,
  4. Victor D Dinglas5,6,
  5. Tom Greene4,
  6. Ramona O Hopkins1,2,7,
  7. Dale M Needham5,6,8
  8. with the National Institutes of Health NHLBI ARDS Network
  1. 1 Center for Humanizing Critical Care, Intermountain Healthcare, Murray, Utah, USA
  2. 2 Department of Medicine, Pulmonary and Critical Care Division, Intermountain Medical Center, Murray, Utah, USA
  3. 3 Pulmonary and Critical Care, University of Utah School of Medicine, Salt Lake City, Utah, USA
  4. 4 Study Design and Biostatistics Center and Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
  5. 5 Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, Maryland, USA
  6. 6 Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
  7. 7 Department of Psychology and Neuroscience Center, Brigham Young University, Provo, Utah, USA
  8. 8 Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
  1. Correspondence to Dr Samuel M Brown, Shock Trauma Intensive Care Unit, 5121 South Cottonwood Street, Murray, UT 84107, USA; samuel.brown{at}


Purpose With improving short-term mortality in acute respiratory distress syndrome (ARDS), understanding survivors’ posthospitalisation outcomes is increasingly important. However, little is known regarding associations among physical, cognitive and mental health outcomes. Identification of outcome subtypes may advance understanding of post-ARDS morbidities.

Methods We analysed baseline variables and 6-month health status for participants in the ARDS Network Long-Term Outcomes Study. After division into derivation and validation datasets, we used weighted network analysis to identify subtypes from predictors and outcomes in the derivation dataset. We then used recursive partitioning to develop a subtype classification rule and assessed adequacy of the classification rule using a kappa statistic with the validation dataset.

Results Among 645 ARDS survivors, 430 were in the derivation and 215 in the validation datasets. Physical and mental health status, but not cognitive status, were closely associated. Four distinct subtypes were apparent (percentages in the derivation cohort): (1) mildly impaired physical and mental health (22% of patients), (2) moderately impaired physical and mental health (39%), (3) severely impaired physical health with moderately impaired mental health (15%) and (4) severely impaired physical and mental health (24%). The classification rule had high agreement (kappa=0.89 in validation dataset). Female Latino smokers had the poorest status, while male, non-Latino non-smokers had the best status.

Conclusions We identified four post-ARDS outcome subtypes that were predicted by sex, ethnicity, pre-ARDS smoking status and other baseline factors. These subtypes may help develop tailored rehabilitation strategies, including investigation of combined physical and mental health interventions, and distinct interventions to improve cognitive outcomes.

  • ARDS
  • outcomes
  • prediction
  • mental health
  • physical function
  • health-related quality of life

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  • Twitter Follow Samuel M Brown @DrSamuelBrown

  • Contributors SMB, ROH, APP, TG and DMN designed the study. SMB, APP, TG, VDD, DMN and ELW analysed and interpreted the data. SMB, ROH and DMN drafted the report, and all other authors revised it. All authors gave final approval of the report to be published.

  • Funding National Heart Lung and Blood Institute (R21HL123433, N01HR56170, R01HL091760, R01HL091760:02S1, and contracts HHSN268200536165C to HHSN268200536175C and HHSN268200536179C).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement In order to protect patient privacy and comply with relevant regulations, identified data are unavailable. Requests for deidentified data from qualified researchers with appropriate ethics board approvals and relevant data use agreements will be processed by the Intermountain Office of Research,

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