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Med."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Acute respiratory distress syndrome (ARDS) remains a major challenge in critical care, with mortality exceeding 40%. Its diagnosis and management depend on multi-step procedures, invasive arterial blood gas analysis, and subjective CT interpretation, often leading to inconsistency, delayed intervention, and increased procedural burden. To address these limitations, we develop AutoARDS, an all-in-one foundation model that transforms routine chest CT into a quantitative platform, enabling integrated and reproducible assessment of diagnosis, progression, oxygenation, physiology, and prognosis within a single, non-invasive workflow, thereby supporting faster and more standardized critical-care decisions. Technically, AutoARDS proposes to employ a multi-task pretraining strategy with adversarial perturbation, distilling routine but unstructured clinical data into unified representations for fine-grained pathological learning. Trained on over 50,000 CT volumes and validated across six medical centers (6,153 individuals), AutoARDS (1) established a reproducible CT-derived biomarker linking morphological injury with disease severity, enabling standardized tracking of pulmonary progression; (2) accurately diagnosed acute respiratory failure and ARDS (AUCs = 0.97 and 0.87), facilitating early recognition and reducing diagnostic delay; (3) directly estimated the P\/F ratio (PCC = 0.83), outperforming SpO\n                    <jats:sub>2<\/jats:sub>\n                    -based monitoring for noninvasive severity stratification and ventilation management; and (4) predicted 28-day outcomes (time-averaged AUC = 0.79), providing complementary risk assessment for clinical planning. Further analyses confirm generalizability to ARDS-associated right ventricular dysfunction (AUC = 0.76) and revealed a positive shift image-derived age residuals, reflecting disease-related imaging patterns that resemble pulmonary aging. By bridging visual information with quantitative physiology, AutoARDS exemplifies a scalable blueprint for transforming chest CT into an integrated, quantitative platform for precise and reproducible critical-care management.\n                  <\/jats:p>","DOI":"10.1038\/s41746-026-02648-9","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T09:06:34Z","timestamp":1777021594000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["CT-based AI system for quantitative and integrated management of acute respiratory distress syndrome in critical care"],"prefix":"10.1038","volume":"9","author":[{"given":"Yuetan","family":"Chu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianpeng","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peiyao","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongheng","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiannan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yilan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingnan","family":"Ju","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaxin","family":"Xiong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiqing","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiuyue","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongyu","family":"Shi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingbo","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tinghui","family":"Qiu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiqi","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quankuan","family":"Gu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping","family":"Hang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiuyue","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaman","family":"Guan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renpei","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ci","family":"Han","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaoyu","family":"Gu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changsong","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Kang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaowen","family":"Qiu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Ge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gongning","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaijiang","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingyan","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianglin","family":"Meng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"key":"2648_CR1","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1038\/s41572-019-0069-0","volume":"5","author":"MA Matthay","year":"2019","unstructured":"Matthay, M. 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