Abstract
Acute respiratory distress syndrome (ARDS) is a highly heterogeneous syndrome that can exhibit significant differences in the underlying causes, leading to different responses to treatment. It is required to identify subtypes of ARDS to guideline clinical treatment and trial design. The study aimed to identify subtypes of ARDS using latent class analysis (LCA). The study was a secondary analysis of the EDEN study, which was a randomized, controlled, multicenter trial conducted from January 2, 2008 to April 12, 2011. The primary study endpoint was death through 90-day follow up. LCA was performed incorporating variables on day 0 before randomization. The number of classes was chosen by a bootstrapped likelihood ratio test, Bayesian information criterion and the number of patients in each class. A total of 943 patients were enrolled in the study, including 219 (23.2%) non-survivors and 724 (76.8%) survivors. The LCA identified three classes of ARDS. Class 1 (hemodynamically unstable type) had significantly higher mortality rate (p = 0.003) than class 2 (intermediate type) and 3 (stable type) through 90 days follow up. There was significant interaction between cumulative fluid balance and the class (p = 0.02). While more fluid balance was beneficial for class 1, it was harmful for class 2 and 3. In conclusion, the study identified three classes of ARDS, which showed different clinical presentations, responses to fluid therapy and prognosis. The classification system used simple clinical variables and could help to design ARDS trials in the future.
Highlights
Acute respiratory distress syndrome (ARDS) is a clinical syndrome manifested by acute onset of respiratory failure requiring medical intervention
Despite strenuous efforts being made to improve the clinical outcomes of ARDS (Steinberg et al, 2006; Mansur et al, 2015; Zhang, Chen & Ni, 2015; Kacmarek et al, 2016; Artigas et al, 2017), the mortality rate remains unacceptably high (Frenzel et al, 2011; Dalhoff et al, 2012; Bellani et al, 2016; Wang et al, 2016)
ARDS is classified as a syndrome because these patients share some common features in clinical presentations such as the acute onset, diffuse bilateral infiltrates in chest X-ray and low oxygenation as reflected by the PaO2/FiO2 (P/F) ratio (ARDS Definition Task Force et al, 2012)
Summary
Acute respiratory distress syndrome (ARDS) is a clinical syndrome manifested by acute onset of respiratory failure requiring medical intervention. Latent class analysis (LCA) can help to find classes or subtypes of cases in multivariate data. It has been widely used in economics, business and psychology (Krauss et al, 2017; Nouwens et al, 2017). A variety of clinical and laboratory variables were collected in clinical trials involving ARDS patients. These data provided a good opportunity to establish a latent class model to identify subtypes of ARDS that can have different treatment responses. The response to fluid balance was compared between ARDS subtypes
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