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Identifying a hyperinflammatory subphenotype of ARDS associated with worse outcomes: may ferritin help?
  1. Lisa K Torres1,2,
  2. Ilias I Siempos3
  1. 1 NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
  2. 2 Department of Medicine, Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, New York, USA
  3. 3 First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
  1. Correspondence to Dr Ilias I Siempos, National and Kapodistrian University of Athens, Athens, Greece; isiempos{at}

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Attributable mortality of acute respiratory distress syndrome (ARDS) is considerable.1 2 Yet, no survival benefit has been shown in randomised controlled trials (RCTs) of pharmacological strategies to treat ARDS. This is assumed to be a consequence of the heterogeneity of clinical and biological processes among patients meeting criteria for ARDS.3

In an attempt to address heterogeneity, recent efforts have led to elucidation of the role of respiratory microbiome4 and to identification both in patients at risk of ARDS5 and in patients with ARDS6 of reproducible subphenotypes, such as the ‘hypoinflammatory’ and ‘hyperinflammatory’ subphenotypes; the latter being associated with worse outcomes. Those subphenotypes were identified through post hoc analyses of clinical and plasma biomarker data of patients enrolled in RCTs or in observational studies.5 6 Implementation of subphenotypes in clinical practice has so far been limited due to lack of prospective validation as well as the need for rapid, real-time measurement of multiple biomarkers needed to stratify patients. Moreover, measurement of those biomarkers can only be undertaken in the research laboratory setting. Therefore, it would be desirable if, instead of multiple biomarkers, a single marker that is routinely available in the clinical setting could be used to stratify patients and, specifically, identify patients with ARDS at risk for worse outcomes.

In this issue of the journal, Mehta et …

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  • Contributors Both authors contributed to study concept and design. LKT wrote the first draft. IIS critically revised the manuscript for important intellectual content and supervised the study. Both authors read and approved the final manuscript.

  • Funding LKT is supported by funding from the National Institutes of Health (K23 GM151730-01). IIS is supported by a grant from the Hellenic Foundation for Research and Innovation (HFRI) under the '2nd Call for H.F.R.I. Research Projects to support Post-Doctoral Researchers' (Project 80- 1/15.10.2020).

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

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