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We hypothesised that biomarkers of these processes have good diagnostic accuracy for ARDS.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Medline and Scopus were searched for original diagnostic studies using minimally invasive testing. Primary outcome was the diagnostic accuracy per test and was categorised by control group. The methodological quality was assessed with QUADAS-2 tool. Biomarkers that had an area under the receiver operating characteristic curve (AUROCC) of &gt;0.75 and were studied with minimal bias against an unselected control group were considered to be promising.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Forty-four articles were included. The median AUROCC for all evaluated tests was 0.80 (25th to 75th percentile: 0.72\ufffd0.88). The type of control group influenced the diagnostic accuracy (p=0.0095). Higher risk of bias was associated with higher diagnostic accuracy (AUROCC 0.75 for low-bias, 0.77 for intermediate-bias and 0.84 for high-bias studies; p=0.0023). Club cell protein 16 and soluble receptor for advanced glycation end-products in plasma and two panels with biomarkers of oxidative stress in breath showed good diagnostic accuracy in low-bias studies that compared ARDS patients to an unselected intensive care unit (ICU) population.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>This systematic review revealed only four diagnostic tests fulfilling stringent criteria for a promising biomarker in a low-bias setting. For implementation into the clinical setting, prospective studies in a general unselected ICU population with good methodological quality are needed.<\/jats:p>\n<\/jats:sec>","DOI":"10.1183\/23120541.00504-2020","type":"journal-article","created":{"date-parts":[[2020,10,15]],"date-time":"2020-10-15T18:55:42Z","timestamp":1602788142000},"page":"00504-2020","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["Systematic review of diagnostic methods for acute respiratory distress syndrome"],"prefix":"10.1183","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4629-4465","authenticated-orcid":false,"given":"Laura A.","family":"Hagens","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nanon F.L.","family":"Heijnen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marry R.","family":"Smit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus J.","family":"Schultz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4224-6426","authenticated-orcid":false,"given":"Dennis C.J.J.","family":"Bergmans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronny M.","family":"Schnabel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2911-4549","authenticated-orcid":false,"given":"Lieuwe D.J.","family":"Bos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2020,10,15]]},"reference":[{"key":"2024101708274552000_7.1.00504-2020.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1608077"},{"key":"2024101708274552000_7.1.00504-2020.2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.5669"},{"key":"2024101708274552000_7.1.00504-2020.3","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1038\/s41572-019-0069-0","article-title":"Acute respiratory distress syndrome","volume":"5","author":"Matthay","year":"2019","journal-title":"Nat Rev Dis Primers"},{"key":"2024101708274552000_7.1.00504-2020.4","doi-asserted-by":"publisher","DOI":"10.1152\/ajplung.00195.2012"},{"key":"2024101708274552000_7.1.00504-2020.5","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/j.chest.2017.11.037","article-title":"Interobserver reliability of the Berlin ARDS definition and strategies to improve the reliability of ARDS diagnosis","volume":"153","author":"Sjoding","year":"2018","journal-title":"Chest"},{"key":"2024101708274552000_7.1.00504-2020.6","doi-asserted-by":"publisher","DOI":"10.1097\/MCC.0000000000000048"},{"key":"2024101708274552000_7.1.00504-2020.7","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000097"},{"key":"2024101708274552000_7.1.00504-2020.8","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.149.3.7509706"},{"key":"2024101708274552000_7.1.00504-2020.9","doi-asserted-by":"publisher","DOI":"10.1059\/0003-4819-155-8-201110180-00009"},{"key":"2024101708274552000_7.1.00504-2020.10","doi-asserted-by":"publisher","DOI":"10.3348\/kjr.2015.16.6.1188"},{"key":"2024101708274552000_7.1.00504-2020.11","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1007\/s00408-017-9989-1","article-title":"Involvement of the Bufadienolides in the detection and therapy of the acute respiratory distress syndrome","volume":"195","author":"Abbas","year":"2017","journal-title":"Lung"},{"key":"2024101708274552000_7.1.00504-2020.12","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e3181feb46a"},{"key":"2024101708274552000_7.1.00504-2020.13","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-002-1220-y"},{"key":"2024101708274552000_7.1.00504-2020.14","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-017-05574-9"},{"key":"2024101708274552000_7.1.00504-2020.15","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e3182978f91"},{"key":"2024101708274552000_7.1.00504-2020.16","doi-asserted-by":"publisher","DOI":"10.1136\/thorax.55.1.46"},{"key":"2024101708274552000_7.1.00504-2020.17","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.164.4.2010111"},{"key":"2024101708274552000_7.1.00504-2020.18","doi-asserted-by":"crossref","unstructured":"Bos LDJ , Weda H, Wang Y, et al. 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