Identifying a hyperinflammatory subphenotype of ARDS associated with worse outcomes: may ferritin help?

• Published in: Thorax Vol. 79; no. 3; pp. 200 - 201
• Main Authors: Torres, Lisa K, Siempos, Ilias I
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and British Thoracic Society 29.01.2024; BMJ Publishing Group LTD
• Subjects: Anesthesia; ARDS; Biomarkers; Cell death; Clinical medicine; COVID-19; Critical Care; Editorial; Ferritins; Humans; Hypoxemia; Latent class analysis; Mortality; Patients; Phenotype; Respiratory Distress Syndrome; Sepsis; Survival analysis; Thorax; Critical Care; ARDS; Hypoxemia
• ISSN: 0040-6376; 1468-3296
• DOI: 10.1136/thorax-2023-221131

[...]measurement of those biomarkers can only be undertaken in the research laboratory setting. [...]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. [...]the authors performed a mediation analysis demonstrating that the association between ferritin and mortality was mediated by interleukin (IL) 18 to a small but statistically significant effect, after adjustment for confounders, such as aetiology of ARDS and APACHE II Score. [...]the authors selected a single and widely available in the clinical practice marker (namely, ferritin) to identify patients with ARDS at risk for high mortality. Data regarding the trajectories of subphenotypes in critical illness is limited so far.16 One study extended latent class analysis in two RCTs of patients with ARDS on day 3, where two subphenotypes were again evident.17 That study found that >94% of patients stayed in their corresponding subphenotype class on day 3.17 However, whether the inflammatory burden and disease implications of the subphenotypes identified at baseline and day 3 are the same is unknown.18 Use of trajectory data will be of critical importance in future studies to gain deeper understanding of the temporal kinetics of a particular subphenotype, as well as whether disease states may be modified by treatment.