%0 Journal Article %A Laura A. Hagens %A Nanon F.L. Heijnen %A Marry R. Smit %A Marcus J. Schultz %A Dennis C.J.J. Bergmans %A Ronny M. Schnabel %A Lieuwe D.J. Bos %A , %T Systematic review of diagnostic methods for Acute Respiratory Distress Syndrome %D 2020 %R 10.1183/23120541.00504-2020 %J ERJ Open Research %P 00504-2020 %X 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 minimal invasive testing. Primary outcome was the diagnostic accuracy per test and 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 more than 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.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interest: Dr. Hagens has nothing to disclose.Conflict of interest: Dr. Heijnen has nothing to disclose.Conflict of interest: Dr. Smit has nothing to disclose.Conflict of interest: Dr. Schultz has nothing to disclose.Conflict of interest: Dr. Bergmans has nothing to disclose.Conflict of interest: Dr. Schnabel has nothing to disclose.Conflict of interest: Dr. Bos reports grants from the Dutch lung foundation (Young investigator grant), grants from the Dutch lung foundation (Public-Private Partnership grant), grants from the Dutch lung foundation (Dirkje Postma Award), outside the submitted work. %U https://openres.ersjournals.com/content/erjor/early/2020/09/24/23120541.00504-2020.full.pdf