Kao et al. have reported in Critical Care the histological findings of
101 patients with acute respiratory distress syndrome (ARDS) undergoing open
lung biopsy. Diffuse alveolar damage (DAD), the histological hallmark of ARDS,
was present in only 56.4 % of cases. The presence of DAD was associated with
higher mortality. Evidence from this and other studies indicates that the
clinical criteria for the diagnosis of ARDS identify DAD in only about half of
the cases. On the contrary, there is evidence that the clinical course and
outcome of ARDS differs in patients with DAD and in patients without DAD. The
discovery of biomarkers for the physiological (increased alveolocapillary
permeability) or histological (DAD) hallmarks of ARDS is thus of paramount
importance.
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