2026-04-13T02:25:19Zhttps://recercat.cat/oai/requestoai:recercat.cat:11351/106182025-10-24T10:28:51Zcom_2072_378070com_2072_378040col_2072_378092
2025-10-24T10:28:51Z
urn:hdl:11351/10618
Subphenotypes in patients with acute respiratory distress syndrome treated with high-flow oxygen
Pierre-Louis, Blot
Chousterman, Benjamin Glenn
Santafe Colomina, Manel
Cartailler, Jerome
Pacheco Reyes, Andres Francisco
Magret, Mònica
Marcadors bioquímics
Oxigenoteràpia
SRAG (Malaltia) - Tractament
DISEASES::Respiratory Tract Diseases::Lung Diseases::Respiratory Distress Syndrome, Adult
Other subheadings::Other subheadings::/therapy
CHEMICALS AND DRUGS::Inorganic Chemicals::Elements::Chalcogens::Oxygen
Other subheadings::Other subheadings::/therapeutic use
CHEMICALS AND DRUGS::Biological Factors::Biomarkers
ENFERMEDADES::enfermedades respiratorias::enfermedades pulmonares::síndrome de dificultad respiratoria del adulto
Otros calificadores::Otros calificadores::/terapia
COMPUESTOS QUÍMICOS Y DROGAS::compuestos inorgánicos::elementos::calcógenos::oxígeno
Otros calificadores::Otros calificadores::/uso terapéutico
COMPUESTOS QUÍMICOS Y DROGAS::factores biológicos::biomarcadores
Acute respiratory distress syndrome; Biomarkers; High-flow nasal oxygen
Síndrome de dificultat respiratòria aguda; Biomarcadors; Oxigen nasal d'alt flux
Síndrome de dificultad respiratoria aguda; Biomarcadores; Oxígeno nasal de alto flujo
Background
Acute respiratory distress syndrome (ARDS) subphenotypes differ in outcomes and treatment responses. Subphenotypes in high-flow nasal oxygen (HFNO)-treated ARDS patients have not been investigated.
Objectives
To identify biological subphenotypes in HFNO-treated ARDS patients.
Methods
Secondary analysis of a prospective multicenter observational study including ARDS patients supported with HFNO. Plasma inflammation markers (interleukin [IL]-6, IL-8, and IL-33 and soluble suppression of tumorigenicity-2 [sST2]) and lung epithelial (receptor for advanced glycation end products [RAGE] and surfactant protein D [SP-D]) and endothelial (angiopoietin-2 [Ang-2]) injury were measured. These biomarkers and bicarbonate were used in K-means cluster analysis to identify subphenotypes. Logistic regression was performed on biomarker combinations to predict clustering. We chose the model with the best AUROC and the lowest number of variables. This model was used to describe the HAIS (High-flow ARDS Inflammatory Subphenotype) score.
Results
Among 41 HFNO patients, two subphenotypes were identified. Hyperinflammatory subphenotype (n = 17) showed higher biomarker levels than hypoinflammatory (n = 24). Despite similar baseline characteristics, the hyperinflammatory subphenotype had higher 60-day mortality (47 vs 8.3% p = 0.014) and longer ICU length of stay (22.0 days [18.0–30.0] vs 39.5 [25.5–60.0], p = 0.034). The HAIS score, based on IL-8 and sST2, accurately distinguished subphenotypes (AUROC 0.96 [95%CI: 0.90–1.00]). A HAIS score ≥ 7.45 was predictor of hyperinflammatory subphenotype.
Conclusion
ARDS patients treated with HFNO exhibit two biological subphenotypes that have similar clinical characteristics, but hyperinflammatory patients have worse outcomes. The HAIS score may identify patients with hyperinflammatory subphenotype and might be used for enrichment strategies in future clinical trials.
The princeps study was supported, in part, by a grant from Instituto de Salud Carlos III-Fondo Europeo de Desarrollo Regional (FEDER) (PI14/01420) and a grant from Federación Española del Enfermo Crítico (FEEC) 2015. No specific support was done for this re-analysis.
2025-10-24T10:28:51Z
2025-10-24T10:28:51Z
2023-11-16T13:40:15Z
2023-11-16T13:40:15Z
2023-11-01
info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
http://hdl.handle.net/11351/10618
Critical Care;27
https://doi.org/10.1186/s13054-023-04687-0
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
info:eu-repo/semantics/openAccess
BMC
Scientia