Understanding patient outcomes after acute respiratory distress syndrome: identifying subtypes of physical, cognitive and mental health outcomes
Open accessAbstract
PURPOSE: With improving short-term mortality in acute respiratory distress syndrome (ARDS), understanding survivors' posthospitalisation outcomes is increasingly important. However, little is known regarding associations among physical, cognitive and mental health outcomes. Identification of outcome subtypes may advance understanding of post-ARDS morbidities. METHODS: We analysed baseline variables and 6-month health status for participants in the ARDS Network Long-Term Outcomes Study. After division into derivation and validation datasets, we used weighted network analysis to identify subtypes from predictors and outcomes in the derivation dataset. We then used recursive partitioning to develop a subtype classification rule and assessed adequacy of the classification rule using a kappa statistic with the validation dataset. RESULTS: Among 645 ARDS survivors, 430 were in the derivation and 215 in the validation datasets. Physical and mental health status, but not cognitive status, were closely associated. Four distinct subtypes were apparent (percentages in the derivation cohort): (1) mildly impaired physical and mental health (22% of patients), (2) moderately impaired physical and mental health (39%), (3) severely impaired physical health with moderately impaired mental health (15%) and (4) severely impaired physical and mental health (24%). The classification rule had high agreement (kappa=0.89 in validation dataset). Female Latino smokers had the poorest status, while male, non-Latino non-smokers had the best status. CONCLUSIONS: We identified four post-ARDS outcome subtypes that were predicted by sex, ethnicity, pre-ARDS smoking status and other baseline factors. These subtypes may help develop tailored rehabilitation strategies, including investigation of combined physical and mental health interventions, and distinct interventions to improve cognitive outcomes.
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Patients admitted to an intensive care unit commonly experience psychological distress after discharge.
“Patients who are sick enough to be admitted to an intensive care unit (ICU) commonly experience symptoms of psychological distress after discharge”
From Effects of mindfulness training programmes delivered by a self-directed mobile app and by telephone compared with an education programme for survivors of critical illness: A pilot randomised clinical trial (2019) · cites this paper as [4]
The Introduction (page unavailable) says ARDS survivors frequently experience persistent mental-health impairments, including anxiety, after discharge. This supports the claim for ARDS survivors, but the source does not establish how common psychological distress is among ICU patients generally. (LLM, conf=0.86)
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- Authors
- Brown, S. M., Wilson, E. L., Presson, A. P., Dinglas, V. D., Greene, T., Hopkins, R. O., & Needham, D. M.
- Affiliations
- Intermountain Healthcare (US)
- University of Utah (US)
- Johns Hopkins University (US)
- Brigham Young University (US)
- Corresponding author
- Brown, Samuel M
- Venue
- Thorax
- Publisher
- BMJ
- Published
- 2017-08-04
- Volume
- 72
- Issue
- 12
- Pages
- 1094-1103
- ISSN
- 0040-6376 (ISSN-L)
- 1468-3296
- PMC
- PMC5690818
- OpenAlex
- W2742184848
- Cited by
- 82
- References
- 58
- Citations by year
- 2026: 7 · 2025: 12 · 2024: 8 · 2023: 3 · 2022: 8 · 2021: 15 · 2020: 11 · 2019: 5 · 2018: 11 · 2017: 2
- FWCI
- 6.56
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Thorax (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- National Heart, Lung, and Blood Institute
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Neonatal Respiratory Health Research
- Keywords
- acute respiratory distress syndrome, physical health, cognitive function, mental health, ARDS survivors, sex differences, ethnicity, smoking, rehabilitation
- MeSH terms
- Acute Disease, Adult, Age Factors, Mental Disorders, Cognition Disorders, Female, Follow-Up Studies, Hispanic or Latino, Humans, Male, Middle Aged, Prognosis, Psychiatric Status Rating Scales, Quality of Life, Respiratory Distress Syndrome, Risk Factors, Severity of Illness Index, Sex Factors, Smoking, United States
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