Abstract
Acute respiratory distress syndrome (ARDS) remains a significant challenge due to its heterogeneity and lack of targeted therapies. Recent advances in biomarkers offer promise in refining diagnosis, assessing severity, and personalizing treatment strategies. This article explores the evolving role of biomarkers in ARDS, highlighting their potential to enhance clinical precision, differentiate subphenotypes, and guide therapeutic interventions.
Key Points
- Heterogeneity of ARDS: ARDS’s diverse presentations complicate diagnosis and treatment, necessitating novel approaches like biomarker integration to improve patient outcomes.
- Revised ARDS Definition: The “New Global Definition of ARDS” includes patients managed with noninvasive ventilation, broadening diagnostic criteria for early intervention.
- Pro- and Anti-Inflammatory Markers: Biomarkers like TNF-α, IL-6, and IL-10 indicate inflammatory status and disease severity, with imbalances impacting prognosis.
- Epithelial and Endothelial Damage: Markers such as sRAGE, KL-6, and Ang-2 provide insights into lung injury severity and alveolar-capillary barrier disruption.
- Coagulopathy and ECM Remodeling: Elevated levels of thrombomodulin, PAI-1, and collagen degradation products reflect coagulopathy and extracellular matrix damage, aiding in prognosis.
- Precision Medicine: Biomarkers facilitate subphenotype identification, distinguishing hyperinflammatory and hypo-inflammatory ARDS, and inform tailored therapies.
- Ventilation Strategies: Biomarker profiles can guide mechanical ventilation adjustments, optimizing outcomes by aligning with specific injury patterns.
- Emerging Technologies: Omics approaches like genomics and proteomics enhance biomarker discovery, paving the way for personalized ARDS management.
- Novel Biomarkers: Circulating cell-free DNA and specific microRNAs are under investigation for their roles in diagnosing and predicting ARDS severity.
- Future Research Needs: Large-scale studies are essential to validate biomarker utility across diverse populations and integrate them into routine clinical practice.
