Attributable mortality of acute respiratory distress syndrome (ARDS) is considerable.1 2 Yet, no survival benefit has been shown in randomised controlled trials (RCTs) of pharmacological strategies to treat ARDS. This is assumed to be a consequence of the heterogeneity of clinical and biological processes among patients meeting criteria for ARDS.3 In an attempt to address heterogeneity, recent efforts have led to elucidation of the role of respiratory microbiome4 and to identification both in patients at risk of ARDS5 and in patients with ARDS6 of reproducible subphenotypes, such as the ‘hypoinflammatory’ and ‘hyperinflammatory’ subphenotypes; the latter being associated with worse outcomes. Those subphenotypes were identified through post hoc analyses of clinical and plasma biomarker data of patients enrolled in RCTs or in observational studies.5 6 Implementation of subphenotypes in clinical practice has so far been limited due to lack of prospective validation as well as the need for rapid, real-time measurement of multiple biomarkers needed to stratify patients. Moreover, measurement of those biomarkers can only be undertaken in the research laboratory setting. Therefore, 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. In this issue of the journal, Mehta et …

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确定与较差结果相关的 ARDS 的高炎症亚表型：铁蛋白有帮助吗？

急性呼吸窘迫综合征 (ARDS) 的归因死亡率相当高。1 2 然而，治疗 ARDS 的药物策略的随机对照试验 (RCT) 尚未显示生存获益。这被认为是符合 ARDS 标准的患者临床和生物过程异质性的结果。3 为了解决异质性，最近的努力阐明了呼吸道微生物组的作用4，并在高危患者中进行了识别ARDS5 和具有可重复亚表型的 ARDS6 患者，例如“低炎症”和“高炎症”亚表型；后者与更糟糕的结果相关。这些亚表型是通过对参加随机对照试验或观察性研究的患者的临床和血浆生物标志物数据进行事后分析而确定的。5 6 由于缺乏前瞻性验证以及需要快速研究，亚表型在临床实践中的实施迄今为止受到限制。 ，实时测量对患者进行分层所需的多种生物标志物。此外，这些生物标志物的测量只能在研究实验室环境中进行。因此，如果可以使用临床环境中常规可用的单一标记物代替多种生物标记物来对患者进行分层，并且特别是识别有可能出现更糟糕结果的 ARDS 患者，那将是可取的。在本期杂志中，梅塔等人……