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Background <p>Acute Respiratory Distress Syndrome (ARDS) encompasses heterogenous subphenotypes. We assessed whether morphological subphenotypes of Acute Pancreatitis-related ARDS have differential responses to prone position and positive end-expiratory pressure (PEEP).</p> Methods <p>We analyzed a retrospective cohort of all consecutive critically ill adults with Acute Pancreatitis-related ARDS and early CT-scan admitted to ICU from 2003 to 2023. ARDS was classified according to CT-scan as “Focal ARDS” or “Non-Focal ARDS.” The primary outcome was 90-day mortality. Treatment effects for prone position and high PEEP were assessed. Adjusted Hazard Ratios (aHR) were calculated with a multivariate Cox analysis. Machine-learning models were developed with XGBoost and explained with SHAP.</p> Results <p>Among the 5,865 patients screened, 151 Acute Pancreatitis-related ARDS were included in the analysis. Eighty-one patients (54%) were classified as Focal ARDS and 70 patients (46%) as Non-Focal ARDS. There was no significant difference in ARDS management. The overall 90-day mortality was of 37% (56/151). There was no significant difference in 90-day mortality between Focal and Non-Focal ARDS (33/81 [41%] vs 33/70 [34%], adjusted Hazard Ratio (aHR): 1.01 [0.58–1.76], p = 0.98). Prone position was associated with lower 90-day mortality in Focal ARDS (aHR: 0.25 [0.08 – 0.76], p = 0.015) but not in Non-Focal ARDS. High PEEP was associated with lower 90-day mortality in Non-Focal ARDS (aHR: 0.22 [0.06–0.85], p = 0.029) but not in Focal ARDS. Machin-learning models concurred with differential responses to prone position and PEEP.</p> Conclusion <p>Two morphological subphenotypes of Acute Pancreatitis–related ARDS were identified and were evenly distributed. Although their clinical characteristics and outcomes were comparable, they exhibited treatment-specific responses: prone positioning was associated with lower mortality in Focal ARDS, whereas high PEEP was associated with lower mortality in Non-Focal ARDS. These findings suggest that morphology may help guide personalized ventilatory strategies in this specific ARDS population.</p>

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Morphological subphenotypes of acute pancreatitis-related acute respiratory distress syndrome

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月16日

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  • Joris Pensier,
  • Maha Touaibia,
  • Mohamad Azhar Meerun,
  • Philippe Hefteh,
  • Nicolas Bloncourt,
  • Aurélie Vonarb,
  • Albert Prades,
  • Bader al Taweel,
  • Antoine Debourdeau,
  • Laurent Monino,
  • Gérald Chanques,
  • Nicolas Molinari,
  • Audrey de Jong,
  • Boris Guiu,
  • Samir Jaber

摘要

Background

Acute Respiratory Distress Syndrome (ARDS) encompasses heterogenous subphenotypes. We assessed whether morphological subphenotypes of Acute Pancreatitis-related ARDS have differential responses to prone position and positive end-expiratory pressure (PEEP).

Methods

We analyzed a retrospective cohort of all consecutive critically ill adults with Acute Pancreatitis-related ARDS and early CT-scan admitted to ICU from 2003 to 2023. ARDS was classified according to CT-scan as “Focal ARDS” or “Non-Focal ARDS.” The primary outcome was 90-day mortality. Treatment effects for prone position and high PEEP were assessed. Adjusted Hazard Ratios (aHR) were calculated with a multivariate Cox analysis. Machine-learning models were developed with XGBoost and explained with SHAP.

Results

Among the 5,865 patients screened, 151 Acute Pancreatitis-related ARDS were included in the analysis. Eighty-one patients (54%) were classified as Focal ARDS and 70 patients (46%) as Non-Focal ARDS. There was no significant difference in ARDS management. The overall 90-day mortality was of 37% (56/151). There was no significant difference in 90-day mortality between Focal and Non-Focal ARDS (33/81 [41%] vs 33/70 [34%], adjusted Hazard Ratio (aHR): 1.01 [0.58–1.76], p = 0.98). Prone position was associated with lower 90-day mortality in Focal ARDS (aHR: 0.25 [0.08 – 0.76], p = 0.015) but not in Non-Focal ARDS. High PEEP was associated with lower 90-day mortality in Non-Focal ARDS (aHR: 0.22 [0.06–0.85], p = 0.029) but not in Focal ARDS. Machin-learning models concurred with differential responses to prone position and PEEP.

Conclusion

Two morphological subphenotypes of Acute Pancreatitis–related ARDS were identified and were evenly distributed. Although their clinical characteristics and outcomes were comparable, they exhibited treatment-specific responses: prone positioning was associated with lower mortality in Focal ARDS, whereas high PEEP was associated with lower mortality in Non-Focal ARDS. These findings suggest that morphology may help guide personalized ventilatory strategies in this specific ARDS population.