In acute respiratory distress syndrome (ARDS), two phenotypes based on the severity of systemic inflammation have been established. But the presence of these phenotypes with COVID-19 is not certain. This study aims to investigate the prevalence of ARDS phenotypes in critically ill patients with COVID-19.

This prospective observational study included a total of 39 patients with ARDS due to COVID-19. The researchers analyzed the plasma samples of the patients for interleukin-6 (IL-6) and soluble tumor necrosis factor receptor superfamily member 1A (TNFR1). The primary outcome of the study was the probability of the hyperinflammatory phenotype in COVID-19 calculated using a parsimonious regression classifier model.

Of 39 patients, 17 (44%) had died by the 28th day of the study. When compared with the survivors, patients who died were older and had lower PaO2/FiO2. The findings suggested that the median probability of the hyperinflammatory phenotype was 0.03. Further analysis indicated that the prevalence of hyperinflammatory phenotype was between 4 (10%) and 8 (21%). In addition, 12 of 31 patients (39%) with the hyperinflammatory phenotype and 5 of 8 patients (63%) with the hyperinflammatory phenotype died.

The research concluded that ARDS due to COVID-19 was associated with a lower prevalence of hyperinflammatory phenotype than historical ARDS data.