Researchers have identified estimated plasma volume status (ePVS) as a potential predictor of acute respiratory distress syndrome (ARDS) development in patients with sepsis, according to findings from a large multicentre retrospective cohort study.
Sepsis-associated ARDS (SA-ARDS) is one of the most serious complications of sepsis and is linked to high rates of mortality and intensive care utilisation. Early identification of patients at greatest risk remains a clinical priority, as timely intervention may improve outcomes.
Elevated ePVS Associated with ARDS Development
The study analysed data from 3,854 adults diagnosed with sepsis according to Sepsis-3 criteria across multiple centres in China. Researchers evaluated whether ePVS, a readily obtainable estimate of plasma volume derived from routine clinical measurements, could help identify patients at risk of developing SA-ARDS.
Across all statistical models, higher ePVS was independently associated with an increased likelihood of developing ARDS. The association remained significant after adjustment for potential confounding factors and was confirmed using propensity score matching and inverse probability weighting analyses.
Receiver operating characteristic analysis demonstrated good predictive performance, with an area under the curve (AUC) of 0.772 for identifying patients who subsequently developed SA-ARDS.
Worse Outcomes in Patients with SA-ARDS
Patients who developed ARDS experienced substantially poorer clinical outcomes than those who did not. Mortality rates were significantly higher among patients with SA-ARDS, affecting 31.8% of cases compared with 23.1% of patients without ARDS.
In addition, patients with SA-ARDS were considerably more likely to require mechanical ventilation and continuous renal replacement therapy, highlighting the significant healthcare burden associated with the condition.
Marker Linked to Disease Severity
Further analysis revealed that ePVS levels increased alongside ARDS severity. The marker was particularly effective at distinguishing between mild and moderate forms of ARDS, suggesting it may have value not only in predicting disease onset but also in assessing disease progression.
Researchers also observed that patients whose sepsis originated from pulmonary infections had significantly higher ePVS values than those with non-pulmonary sources of infection.
Potential Role in Risk Stratification
Although ePVS alone demonstrated limited predictive value for in-hospital mortality among patients with established SA-ARDS, its combination with the Acute Physiology and Chronic Health Evaluation II (APACHE II) score significantly improved prognostic accuracy.
The authors concluded that ePVS may represent a practical and accessible biomarker for identifying patients at elevated risk of SA-ARDS and poor outcomes. They suggest that incorporating ePVS into existing risk assessment strategies could help support earlier recognition, closer monitoring, and more personalised management of patients with sepsis.
