A Longitudinal NMR‐Based Metabolomics Highlights Shared Mechanisms of Pathophysiology in ARDS Patients With and Without Sepsis

Acute respiratory distress syndrome (ARDS) is a life-threatening condition often complicated by sepsis, leading to worse clinical outcomes. The role of biomarkers in distinguishing ARDS with and without sepsis remains unclear. This study aimed to evaluate the differences in serum metabolites between the two groups, comparing levels on Day 1 and Day 7 of intensive care unit (ICU) admission, and to assess the variation in outcomes via clinical characteristics. A cohort of n = 151 patients was included, with n = 91 providing serum samples on Day 1 and n = 60 on Day 7. Of the n = 91 patients on Day 1, n = 40 had ARDS with sepsis and n = 51 without sepsis, while on Day 7, n = 24 had ARDS with sepsis and n = 36 without. Serum samples were analyzed using ¹H NMR-based metabolomics to identify altered metabolites and perturbed pathways. In contrast, no significant differences were found between the patient groups with and without sepsis on either Day 1 or Day 7. Mortality rates were also similar in both groups, with a 50% survival rate on Day 7. No notable differences in the clinical data were observed. These findings suggest that ARDS, with and without sepsis, exhibits a similar metabolic profile, likely due to shared pathophysiological mechanisms. In light of these similarities, the findings indicate a unified approach to ARDS management that may improve the clinical outcomes across both groups.