title: Acute respiratory distress syndrome: does histology matter?
abstract: 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.
authors.affiliation: Hospital Universitario de Getafe, Carretera de Toledo km 12500, 28905, Madrid, Spain. joseangel.lorente@salud.madrid.org.|CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Calle Sinesio Delgado, 4, 28029, Madrid, Spain. joseangel.lorente@salud.madrid.org.|Universidad Europea de Madrid, Calle Tajo, s/n, 28670, Villaviciosa de Odón, Madrid, Spain. joseangel.lorente@salud.madrid.org.
authors.forename: José A
authors.initials: JA
authors.lastname: Lorente
authors.affiliation: Hospital Universitario de Getafe, Carretera de Toledo km 12500, 28905, Madrid, Spain. aidaesperanza.ballen@salud.madrid.org.
authors.forename: Aida
authors.initials: A
authors.lastname: Ballén-Barragán
authors.affiliation: Hospital Universitario de Getafe, Carretera de Toledo km 12500, 28905, Madrid, Spain. rherrero@salud.madrid.org.|CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Calle Sinesio Delgado, 4, 28029, Madrid, Spain. rherrero@salud.madrid.org.
authors.forename: Raquel
authors.initials: R
authors.lastname: Herrero
authors.affiliation: Hospital Universitario de Getafe, Carretera de Toledo km 12500, 28905, Madrid, Spain. aesteban@ucigetafe.com.|CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Calle Sinesio Delgado, 4, 28029, Madrid, Spain. aesteban@ucigetafe.com.|Universidad Europea de Madrid, Calle Tajo, s/n, 28670, Villaviciosa de Odón, Madrid, Spain. aesteban@ucigetafe.com.
authors.forename: Andrés
authors.initials: A
authors.lastname: Esteban
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D011650:Pulmonary Alveoli / Q000473:pathology*; D012128:Respiratory Distress Syndrome / Q000175:diagnosis* / Q000601:surgery*