Reply: Next Step to Understanding Subphenotypes of Acute Respiratory Distress Syndrome

From the Authors:

We appreciate the interest in our recent publication (1) from Dr. Shimatani and colleagues and thank them for their letter. With regard to the idea that the temporal evolution of acute respiratory distress syndrome (ARDS) may influence subphenotype assignment, we note that all subjects in the FACTT (Fluid and Catheter Treatment Trial) study were enrolled within the first 48 hours of ARDS, but the precise time elapsed between meeting ARDS criteria and plasma sampling for each patient is not available in this data set. In our previous work on ARDS subphenotypes (2), patients were enrolled within the first 36 hours of meeting ARDS criteria, thus narrowing the window further, but again the precise interval between meeting criteria and enrollment for each patient was not available. We agree with the authors that the evolution and stability of ARDS subphenotypes over time is a critically important topic for further study, and we are currently preparing a manuscript on this very topic. We also agree with the letter’s point regarding the potential influence of genotype on ARDS subphenotype and plan to address this topic in our future research as well. We appreciate the authors’ interest and their thoughtful questions regarding our work.