Subphenotypes of Acute Respiratory Distress Syndrome: Advancing Towards Precision Medicine.
Subphenotypes of Acute Respiratory Distress Syndrome: Advancing Towards Precision Medicine.
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DOI：
10.4046/trd.2023.0104
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发表时间：
2024-01
影响因子：
2.9
通讯作者：
Calfee CS
中科院分区：
文献类型：
--
作者：
Levine AR;Calfee CS
急性呼吸窘迫综合征（ARDS）是严重低氧血症的常见原因，其定义为急性发作的双侧非心源性肺水肿。诊断是由确定的共识标准。支持性护理，包括预防肺部进一步损伤，是唯一能最终改善预后的治疗方法。无法找到更先进的治疗方法，部分原因是目前的综合征共识标准高度敏感但相对非特异性，结合了ARDS的异质性患者人群。在缺乏有效治疗的情况下，死亡率保持在30%至40%。已经提出了许多ARDS的亚表型，以聚集具有可观察或可测量特征的共享组合的患者。亚表型患者是克服异质性以推进临床研究并最终确定可治疗特征的一种策略。基于放射学模式、蛋白质生物标志物、转录组学和/或基于机器的临床和生物学变量聚类，已经提出了ARDS的亚表型。其中一些策略在患者队列中是可重复的，但目前所有策略的实施都存在实际限制。此外，对于哪种战略最合适也没有达成一致意见。本文就目前ARDS患者亚表型分型的策略进行综述，包括其优势和局限性，以及未来的发展方向。
Acute respiratory distress syndrome (ARDS) is a common cause of severe hypoxemia defined by the acute onset of bilateral non-cardiogenic pulmonary edema. The diagnosis is made by defined consensus criteria. Supportive care, including prevention of further injury to the lungs, is the only treatment that conclusively improves outcomes. The inability to find more advanced therapies is due, in part, to the highly sensitive but relatively non-specific current syndromic consensus criteria, combining a heterogenous population of patients under the umbrella of ARDS. With few effective therapies, the morality rate remains 30% to 40%. Many subphenotypes of ARDS have been proposed to cluster patients with shared combinations of observable or measurable traits. Subphenotyping patients is a strategy to overcome heterogeneity to advance clinical research and eventually identify treatable traits. Subphenotypes of ARDS have been proposed based on radiographic patterns, protein biomarkers, transcriptomics, and/or machine-based clustering of clinical and biological variables. Some of these strategies have been reproducible across patient cohorts, but at present all have practical limitations to their implementation. Furthermore, there is no agreement on which strategy is the most appropriate. This review will discuss the current strategies for subphenotyping patients with ARDS, including the strengths and limitations, and the future directions of ARDS subphenotyping.
影响因子：
3.9
作者：
Chotalia, Minesh;Patel, Jaimin M.;Bangash, Mansoor N.;Parekh, Dhruv
通讯作者：
Parekh, Dhruv
影响因子：
1.8
作者：
Kim, Na Young;Yoon, Si Mong;Park, Jimyung;Lee, Jinwoo;Lee, Sang-Min;Lee, Hong Yeul
通讯作者：
Lee, Hong Yeul