What question did this study set out to answer?

To determine the incidence of acute respiratory distress syndrome (ARDS) and its clinical and laboratory predictors in septic patients.

May 9, 2026Open Access

Incidence and Predictors of Acute Respiratory Distress Syndrome in Patients With Sepsis: A Two-Year Prospective Cohort Study From Khyber Pakhtunkhwa, Pakistan

Key Points

To determine the incidence of acute respiratory distress syndrome (ARDS) and its clinical and laboratory predictors in septic patients.
Conducted a prospective observational cohort study from March 2023 to February 2025.
Observed adult patients diagnosed with sepsis daily for onset of ARDS according to the Berlin definition.
Performed univariate and multivariable logistic regression analyses to identify independent predictors of ARDS.
Out of 364 septic patients, 108 (29.67%) developed ARDS.
Independent predictors included PaO2/FiO2 <200 mmHg, serum lactate >2 mmol/L, GCS <14, pulmonary infection, SOFA score ≥6, and age ≥60 years.

Abstract

Background: Sepsis is a potentially fatal illness that is often made worse by Acute Respiratory Distress Syndrome (ARDS), which increases morbidity and mortality. Objective: To determine the incidence of acute respiratory distress syndrome (ARDS) and to identify its clinical and laboratory predictors (including serum lactate levels, partial pressure of oxygen/fraction of inspired oxygen PaO2/FiO2 ratio, and the Sequential Organ Failure Assessment SOFA score) among adult patients with sepsis in a prospective observational cohort study. Methodology: A prospective observational cohort study was conducted from March 2023 to February 2025. Following a sequential enrollment process, adult patients (≥18 years) with a diagnosis of sepsis based on Sepsis-3 criteria were observed daily for the onset of ARDS using the Berlin definition. Vital signs, test results, comorbidities, baseline demographics, and the source of infection were all documented. IBM SPSS Statistics for Windows, version 26 (IBM Corp. , Armonk, NY, USA) was used to analyze the data. To find independent predictors of ARDS, univariate and multivariable logistic regression analyses were conducted. Results: A total of 364 septic patients were included, of whom 108 (29. 67%) developed ARDS. ARDS patients were older (mean age 57. 48 ± 15. 79 years), with 65 (60. 19%) male patients. Comorbidities included diabetes mellitus (42, 38. 89%), hypertension (35, 32. 41%), and chronic kidney disease (18, 16. 67%). Pulmonary infection was present in 62 (57. 41%) of ARDS cases. ARDS patients had higher heart rate (107. 23 vs. 100. 45 bpm), respiratory rate (25. 12 vs. 21. 45/min), lower GCS (13. 45 vs. 14. 45), higher SOFA score (6. 78 vs. 4. 32), elevated WBC (16. 34 vs. 12. 34 ×10³/µL), and serum lactate (3. 42 vs. 2. 61 mmol/L). Independent predictors of ARDS were PaO2/FiO2 2 mmol/L, GCS <14, pulmonary infection, SOFA ≥6, and age ≥60 years. Conclusion: Approximately one-third of septic patients developed ARDS, with severity of illness and pulmonary involvement being key predictors.

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