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The acute respiratory distress syndrome (ARDS) prevalence is increasing every year; it is estimated that in the United States alone, about 190K Americans are diagnosed with ARDS each year. Prior to the COVID-19 global pandemic, more than 700K individuals in the US and 2 million cases globally developed ARDS from trauma, sepsis, bacterial, and viral infections, with a cumulative mortality of 40%. The COVID-19 pandemic has highlighted several severe unmet needs in the ARDS domain these include starting with the lack of effective FDA-approved pharmacotherapies, as neither SARS-CoV-2 vaccinations nor anti-SARS-CoV-2 vaccines address the unregulated inflammation that promotes multiorgan failure and ARDS death.
Despite recent advances in translational research and exponential growth in the identification of new biomarkers, precision medicine approaches to ARDS have yet to be deployed, and validated ARDS biomarkers are lacking. This critical unmet need in ARDS emphasizes a crucial gap between the rapid rate of biomarker discovery and effective translation to clinical application, as well as the need for biomarkers to influence a more streamlined drug approval process. The absence of accurate and validated ARDS biomarkers is one of the many reasons why clinical studies in ARDS fail.
Acute Respiratory Distress Syndrome Epidemiology Insights
The recently published report Acute Respiratory Distress Syndrome Epidemiology Forecast highlights that there were approximately 1 million incident cases in the 7MM in 2021. These cases are expected to increase by 2032 at a CAGR of 1.5% during the study period 2019–2032. DelveInsight estimates show a higher incidence of ARDS in the United States, with an estimated number of approximately 630K cases in 2021. Due to the occurrence of COVID-19, there has been a sudden increase in the cases of ARDS in the US from 2019 to 2021
Among the EU-5, Germany had the highest total incident population of ARDS with more than 193K cases, followed by France and Italy. Contrary to the trend, Spain had the lowest numbers. In Asia, Japan had approximately 69K total incident cases of ARDS in 2021, which are expected to increase by 2032 at a CAGR of 0.5% during the study period (2019–2032).
ARDS is segmented into mild, moderate, and severe ARDS on the basis of severity.There were 189K, 293K, and 147K severity-specific cases of mild, moderate, and severe ARDS in the United States. According to DelveInsight's experts, the majority of ARDS cases are moderate, followed by mild and severe, and this is liable to change owing to significant growth in the coming years.there were 189K, 293K, and 147K severity-specific cases of mild, moderate, and severe ARDS in the United States, respectively. According to DelveInsight's experts, the majority of ARDS cases are moderate, followed by mild and severe, and this is liable to change owing to significant growth in the coming years.
Generally, among the 7MM countries, the primary risk factor associated with the highest number of ARDS incident cases was pneumonia, except for the UK, where sepsis was the primary risk factor for ARDS. Furthermore, according to DelveInsight's assessment of severity-specific incidence, a similar pattern is evident in other countries, with the majority of cases indicating moderate ARDS, with the exception of France, where severe cases of ARDS accounted for the majority of the patient population.
According to DelveInsight analysts, the major risk factors for ARDS in the United States in 2021 were pneumonia (188K cases), sepsis (156K cases), aspiration (54K cases), and trauma (16K cases). pancreatitis accounted for the lowest number of patients in the US population reported in 2021. Moreover, COVID-19 emerged as another prominent risk factor for ARDS in 2020, in addition to existing risk factors.
Driving Factors and Epidemiological Trends for ARDS Prevalence
Pneumonia, Sepsis, Aspiration, Trauma, Pancreatitis, COVID-19, and others are among the major driving factors for ARDS prevalence. With the increase in the cases of these factors, the prevalence of ARDS is expected to rise in the coming years. As a result, the future trend of ARDS epidemiology is anticipated to be the same, but pneumonia and COVID-19 are expected to be key factors for the surge in the ARDS prevalence by 2032.
Other the other hand, acute respiratory failure-related mortality has increased at a rate of around 3.4% per year, and there has been no drop in ARDS-related mortality in the previous five years. This concerning tendency is constant across age, gender, race and ethnicity, urbanization, and geographical regions. Identifying these tendencies and adjusting public health and policy planning efforts to them may assist to direct resource and infrastructure organization for the massive morbidity and death burden that is projected in the United States with the full-scale of ARF and ARDS linked with COVID-19.
Impact of COVID-19 on ARDS prevalence
COVID-19 has emerged as a vital factor responsible for ARDS. Initially, ARDS was seen in 1968 in patients showing symptoms like hypoxemia, low pulmonary compliance, non-cardiac pulmonary edema, and increased work of breathing.
There is a possibility that ARDS in patients might have occurred due to pre-existing substances of the host or viral effects. ARDS can be fatal due to the action of neutrophils, eosinophils, proteinases, IL-6, and TNF-α. Their aggravation and excessive tissue damage can lead to fatality. The mechanism of COVID-19 in ARDS is yet to be identified; however, induction of cytokine storm is considered the primary factor to date.
There are some minor differences that can potentially identify ARDS in COVID patients than in non-COVID-19 ARDS, including the time of onset for COVID-19-associated ARDS, which is 8–12 days, whereas the onset time for non-COVID-19 ARDS is approx 7 days. The lung compliance in non-COVID-19 ARDS is less compared to lung compliance in COVID-19 patients. Moreover, a patient becomes more dependent on mechanical ventilation in classic ADRS.
Acute respiratory failure (ARF) is a potentially fatal medical condition that is defined by an increased requirement for ICU admission and is commonly accompanied by the need for mechanical ventilation. ARDS is a potentially lethal disease defined by acute-onset, diffuse, inflammatory lung damage that results in hypoxemic respiratory insufficiency and failure due to increased pulmonary vascular permeability and loss of ventilated lung tissue. ARDS is one of the most common causes of ARF. ARDS affects almost 3 million patients each year, accounting for 10% of ICU admissions and 24% of patients on mechanical ventilation. This potentially lethal respiratory condition can be caused by pulmonary (aspiration, COVID-19, pneumonia, and inhalational injury) or nonpulmonary (trauma, pancreatitis, sepsis, and drug toxicity) causes and has a mortality rate of 35–46%, depending on disease severity at the time of onset.Despite major breakthroughs in the understanding of the pathogenesis, development, and therapy of ARDS and ARF, current statistics on the mortality burden of ARF and ARDS in the United States are inadequate. Importantly, there is little data on mortality rates in the United States following the adoption of the Berlin criteria of ARDS, which was supported by the American Thoracic Society and the Society of Critical Care Medicine and was used in normal clinical care. Geographic disparities in disease treatment and critical care practices are well-known and may influence patient outcomes. There are no current regional disparities in ARF and ARDS mortality in the United States. These geographical disparities may be exacerbated by the enormous infrastructural pressure caused by COVID-19.
Acute respiratory distress syndrome (ARDS) is a fast progressing condition that affects critically ill people. The most serious consequence of ARDS is fluid leaking into the lungs, which makes breathing difficult or impossible.
Shortness of breath, cough, and fever are among ARDS symptoms; in certain cases, high heart rates and rapid breathing have also been observed. Patients with ARDS may have chest pain, particularly during inhalation, and some may also have blue nails and lips owing to drastically reduced oxygen levels in the blood.
Mechanical ventilation, prevention for stress ulcers and venous thromboembolism, nutritional assistance, and therapy of the underlying damage are all part of the acute respiratory distress syndrome treatment.
The ARDS causes are classified as either direct or indirect lung injuries. Pneumonia, aspiration, trauma, and others are direct lung injuries examples. Inflammation of the pancreas, severe infection (also known as sepsis), blood transfusions, burns, and pharmaceutical responses are examples of indirect lung injuries.
Pneumonia, Sepsis, Aspiration, Trauma, Pancreatitis, COVID-19, and others are among the major driving factors for ARDS prevalence.