We identified hyper- and non-hyperinflammatory subphenotypes in patients at risk of ARDS upon presentation to the emergency department. These subphenotypes remained identifiable over time and a hyperinflammatory subphenotype was associated with worse clinical outcomes. Future studies on ARDS may benefit from enriching study populations by identifying subphenotypes through methods applicable to the clinical setting.

Subphenotypes exhibiting hyper- and non-hyper-inflammatory characteristics can be identified in at-risk patients upon presentation to the emergency department, prior to the development of acute respiratory distress syndrome (ARDS).

A hyper-inflammatory subphenotype identified patients with worse clinical outcomes.

Subphenotyping of patients at risk could serve as a potential predictive or prognostic enrichment strategy in clinical trials, allowing for individualized prophylactic treatment of ARDS.

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