Daily Ards Research Analysis

Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) carry high mortality with limited drug therapies. β-agonists are potential candidates due to bronchodilatory and anti-inflammatory effects. This meta-analysis evaluated their efficacy and safety in ALI/ARDS. Randomized controlled trials (RCTs) of β-agonists in ALI/ARDS were identified through PubMed, Cochrane Library, Embase, Web of Science, and Scopus. Relative risks were used for dichotomous outcomes and mean differences for continuous outcomes. The Cochrane tool was used to evaluate bias, and Cochran's Q and the I2 statistics were used to evaluate heterogeneity. Six RCTs involving 1213 participants met the inclusion criteria. Beta-agonists significantly reduced ventilator-free days (mean difference - 1.98, 95% confidence interval [CI]: -3.21 to - 0.75, P = 0.002, I2 = 68%) and intensive care unit (ICU)-free days (-6.57, P = 0.001). They were associated with nonsignificant trend toward higher 28-day mortality (risk ratio: 1.23, P = 0.10) and a significant increase in 90-day mortality (risk ratio: 1.39, 95% CI: 1.03-1.89, P = 0.03). Sensitivity analysis confirmed robust results, showing increased risk of cardiac arrhythmias (risk ratio: 1.89, P = 0.0008) but no significant effect on organ failure-free days (-0.99, P = 0.31). In ARDS/ALI, β-agonists reduce ventilator-and ICU-free days but increase 90-day mortality and arrhythmia risk, with no impact on organ failure-free days. β-agonists are linked to long-term risks, such as increased mortality and arrhythmias, but they provide little clinical benefit in terms of reducing ventilator or intensive care unit time. They have no effect on the incidence of ARDS/ALI or outcomes of organ failure.

Acute respiratory distress syndrome (ARDS) remains a significant cause of morbidity and mortality in the United States. Although advances in critical care have improved outcomes, the Coronavirus Disease of 2019 (COVID-19) pandemic substantially altered ARDS epidemiology, necessitating updated analyses of national mortality trends. To examine 25-year trends (1999-2023) in ARDS-related mortality across demographic, geographic, and urbanization categories, and to evaluate the impact of the COVID-19 pandemic on these patterns. We conducted a population-based descriptive study using CDC WONDER multiple cause-of-death data. ARDS-related deaths were identified by ICD-10 code J80. Crude and age-adjusted mortality rates (AAMRs) per 100,000 population were calculated. Temporal changes were analyzed using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC) with 95% confidence intervals. Mortality rates were stratified by sex, age, race/ethnicity, census region, state, and urban-rural classification. Between 1999 and 2023, 364,924 ARDS-related deaths were recorded. National AAMRs declined steadily from 1999 to 2018 (APC -2.63; 95% confidence interval (CI): -4.74--1.04), surged sharply during 2018 to 2021 (APC 85.78; 95% CI: 53.65-109.16), and decreased between 2021 and 2023 (APC -59.59; 95% CI: -68.58--47.89), resulting in an overall AAPC of -1.90 (95% CI: -3.80-0.19). Males consistently exhibited higher mortality rates than females. Individuals aged ≥ 75 years had the highest AAMRs. Non-Hispanic Black, Hispanic/Latino, and American Indian/Alaska Native populations experienced disproportionately elevated mortality. Rural areas and the South and Midwest regions showed greater increases during the pandemic. California, Texas, Florida, and New York reported the highest cumulative death counts. ARDS mortality in the United States declined for nearly 2 decades but rose sharply during the COVID-19 pandemic, highlighting persistent disparities by age, sex, race, geography, and urbanization. Targeted interventions and equitable critical care access are essential to reduce future ARDS-related deaths. Detailed Visual Abstract is illustrated in the Central Illustration.

BACKGROUND: Acute respiratory distress syndrome (ARDS) is a major complication in hospitalized patients with coronavirus disease 2019 (COVID-19). Early identification of patients at increased risk of ARDS progression and invasive ventilation remains clinically important. This study aimed to investigate whether plasma hyaluronic acid (HA), alone or in combination with established clinical severity scores, could help identify ARDS, stratify severe disease, and assess the risk of endotracheal intubation in patients with COVID-19. METHODS: This retrospective single-center cohort study included 502 adult patients with COVID-19 admitted between September 2022 and February 2023. Plasma HA levels were measured within 24 hours after admission. Demographic characteristics, comorbidities, laboratory findings, clinical severity scores, and outcome data were collected. Receiver operating characteristic analysis, multivariable logistic regression, and nomogram construction were used to evaluate the association of HA with ARDS diagnosis, severe ARDS stratification, and intubation risk. RESULTS: This retrospective cohort analysis of 502 COVID-19 patients (361 in the non-ARDS group and 141 in the ARDS group) identified plasma hyaluronic acid (HA) as a potential biomarker for early ARDS diagnosis, severity stratification, and intubation risk assessment. HA levels were positively correlated with disease severity, with concentrations significantly increasing alongside ARDS severity, and showed good discrimination for ARDS (AUC = 0.904; sensitivity 81.6%, specificity 87.5% at a cut-off of 103 μg/L). HA also demonstrated excellent discrimination for severe ARDS, with an AUC of 0.953, comparable to that of the APACHE II and SOFA scores. It also showed good discrimination for endotracheal intubation risk in the overall cohort. The AUC for predicting intubation requirement reached 0.890 (sensitivity 76.6%, specificity 90.8%, NPV = 95.5% at a cut-off value of 140.1 μg/L). Integrating HA with clinical scores further improved model performance; incorporating age, lymphocyte count, CRP, CK, APACHE II, and SOFA into the baseline model increased the AUC for predicting severe ARDS from 0.960 to 0.973 (ΔAUC = 0.013). Furthermore, multivariable regression analysis showed that HA was independently associated with ARDS diagnosis (OR = 1.04, P = 0.007), severe ARDS (OR = 1.00, P < 0.001), and intubation risk (OR = 1.00, P = 0.011). CONCLUSION: Plasma HA was positively associated with ARDS severity and intubation risk in patients with COVID-19. HA may serve as a complementary biomarker for early risk stratification, particularly when used in combination with established clinical severity scores.