Abstract
Rationale Acute respiratory distress syndrome (ARDS) is currently diagnosed by the Berlin definition, which does not include a direct measure of pulmonary oedema, endothelial permeability or pulmonary inflammation. We hypothesised that biomarkers of these processes have good diagnostic accuracy for ARDS.
Methods Medline and Scopus were searched for original diagnostic studies using minimally invasive testing. Primary outcome was the diagnostic accuracy per test and was categorised by control group. The methodological quality was assessed with QUADAS-2 tool. Biomarkers that had an area under the receiver operating characteristic curve (AUROCC) of >0.75 and were studied with minimal bias against an unselected control group were considered to be promising.
Results Forty-four articles were included. The median AUROCC for all evaluated tests was 0.80 (25th to 75th percentile: 0.72–0.88). The type of control group influenced the diagnostic accuracy (p=0.0095). Higher risk of bias was associated with higher diagnostic accuracy (AUROCC 0.75 for low-bias, 0.77 for intermediate-bias and 0.84 for high-bias studies; p=0.0023). Club cell protein 16 and soluble receptor for advanced glycation end-products in plasma and two panels with biomarkers of oxidative stress in breath showed good diagnostic accuracy in low-bias studies that compared ARDS patients to an unselected intensive care unit (ICU) population.
Conclusion This systematic review revealed only four diagnostic tests fulfilling stringent criteria for a promising biomarker in a low-bias setting. For implementation into the clinical setting, prospective studies in a general unselected ICU population with good methodological quality are needed.
Abstract
Accuracy of diagnosis of acute respiratory distress syndrome (ARDS) is associated with risk of bias. There is a lack of validated diagnostic tests in an unbiased setting, emphasising the need for quality driven diagnostic research in ARDS. https://bit.ly/2GfPAvf
Footnotes
This article has supplementary material available from openres.ersjournals.com.
Members of the DARTS consortium: Amsterdam UMC, Amsterdam, the Netherlands (Laura A. Hagens, Marry R. Smit, Marcus J. Schultz and Lieuwe D.J. Bos); Maastricht UMC, Maastricht, the Netherlands (Nanon F.L. Heijnen, Dennis C.J.J. Bergmans and Ronny M. Schnabel); and Philips Research, Eindhoven, the Netherlands (Alwin R.M. Verschueren, Tamara M.E. Nijsen and Inge Geven).
Conflict of interest: L.A. Hagens has nothing to disclose.
Conflict of interest: N.F.L. Heijnen has nothing to disclose.
Conflict of interest: M.R. Smit has nothing to disclose.
Conflict of interest: M.J. Schultz has nothing to disclose.
Conflict of interest: D.C.J.J. Bergmans has nothing to disclose.
Conflict of interest: R.M. Schnabel has nothing to disclose.
Conflict of interest: L.D.J. Bos reports grants from the Dutch Lung Foundation (young investigator grant, public–private partnership grant and Dirkje Postma Award) outside the submitted work.
Support statement: Lieuwe D.J. Bos is supported by Health Holland via the Dutch Lung Foundation (longfonds) industry–academia partnership and via the Dirkje Postma Award. They had no role in the design, conduct or interpretation of this review.
- Received July 17, 2020.
- Accepted September 18, 2020.
- Copyright ©ERS 2021
This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.