Introduction: Diffuse alveolar hemorrhage (DAH) is a rare but severe complication in patients with acute respiratory distress syndrome (ARDS), with limited data on its impact at the population level. We aimed to evaluate outcomes associated with DAH among hospitalized ARDS patients using a national inpatient dataset. Methods: We conducted a retrospective analysis using the 2022 Nationwide Readmissions Database (NRD). Adult ARDS hospitalizations were identified using ICD-10 codes. The exposure of interest was DAH. Outcomes included in-hospital mortality, ICU-level interventions (mechanical ventilation, vasopressors use, VV ECMO), multiorgan failure (acute kidney injury, liver dysfunction), hospital length of stay, and total charges. Survey-weighted logistic and linear regressions were used to adjust for demographics, comorbidities, and hospital characteristics. Results: Among 110, 652 weighted adult ARDS hospitalizations, 5, 534 had diffuse alveolar hemorrhage (DAH). Patients with DAH were younger (mean age 51. 4 vs. 59. 0 years) and more often female (45. 2% vs. 43. 3%). In adjusted analyses, DAH was independently associated with increased odds of in-hospital mortality (aOR 1. 74, p< 0. 001), invasive mechanical ventilation use (aOR 2. 19, p< 0. 001), and tracheostomy (aOR 1. 50, p = 0. 001). It was also linked to higher odds of shock (aOR 1. 43, p=0. 003), acute kidney injury (aOR 1. 92, p< 0. 001), and liver dysfunction (aOR 1. 49, p=0. 001). Notably, the DAH group had higher odds of VV ECMO utilization (aOR 4. 22, p< 0. 001), reflecting the severity of illness in this subgroup. Additionally, DAH was associated with more extended hospital stays (β = 2. 96 days, p = 0. 017) and higher total hospital charges (β = 189, 972, p< 0. 001). Conclusions: Our study showed that DAH in ARDS is linked to higher in-hospital mortality, greater ICU resource use (shock, ventilation), multiorgan dysfunction (AKI, liver failure), and increased hospital costs. These findings highlight DAH as a high-risk ARDS phenotype requiring early recognition and targeted supportive strategies to improve outcomes and optimize resource use.
Khan et al. (Sun,) studied this question.