{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T21:36:59Z","timestamp":1775857019794,"version":"3.50.1"},"reference-count":47,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,6,5]],"date-time":"2023-06-05T00:00:00Z","timestamp":1685923200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Background: Acute respiratory distress syndrome (ARDS) is a severe lung condition that can be caused by a variety of underlying illnesses. Due to SARS-CoV-2, the number of cases with ARDS has increased worldwide, making it essential to compare this form of acute respiratory failure with classical causes of ARDS. While there have been several studies investigating the differences between COVID-19 and non-COVID-19 ARDS in early stages of the pandemic, little is known about the differences in later phases, especially in Germany. Aim: The aim of this study is to characterize and compare the comorbidities, treatments, adverse events, and outcomes of COVID-19-associated ARDS and non-COVID-19 ARDS using a representative sample of German health claims data from the years 2019 and 2021. Methods: We compare percentages and median values of the quantities of interest from the COVID-19 and non-COVID-19 ARDS group, with p-values calculated after conducting Pearson\u2019s chi-squared test or the Wilcoxon rank sum test. We also run logistic regressions to access the effect of comorbidities on mortality for COVID-19 ARDS and non-COVID-19 ARDS. Results: Despite many similarities, we find that that there are some remarkable differences between COVID-19 and non-COVID-19 ARDS cases in Germany. Most importantly, COVID-19 ARDS cases display fewer comorbidities and adverse events, and are more often treated with non-invasive ventilation and nasal high-flow therapy. Conclusions: This study highlights the importance of comprehending the contrasting epidemiological features and clinical outcomes of COVID-19 and non-COVID-19 ARDS. This understanding can aid in clinical decision making and guide future research initiatives aimed at enhancing the management of patients afflicted with this severe condition.<\/jats:p>","DOI":"10.3390\/v15061324","type":"journal-article","created":{"date-parts":[[2023,6,6]],"date-time":"2023-06-06T01:38:26Z","timestamp":1686015506000},"page":"1324","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Same but Different? Comparing the Epidemiology, Treatments and Outcomes of COVID-19 and Non-COVID-19 ARDS Cases in Germany Using a Sample of Claims Data from 2021 and 2019"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-1686-6974","authenticated-orcid":false,"given":"Eva","family":"Bernauer","sequence":"first","affiliation":[{"name":"BinDoc GmbH, Karlstra\u00dfe 3, 72072 T\u00fcbingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felix","family":"Alebrand","sequence":"additional","affiliation":[{"name":"BinDoc GmbH, Karlstra\u00dfe 3, 72072 T\u00fcbingen, Germany"},{"name":"Clinic for Cardiology and Pneumology, Georg-August-Universit\u00e4t G\u00f6ttingen, 37075 G\u00f6ttingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manuel","family":"Heurich","sequence":"additional","affiliation":[{"name":"BinDoc GmbH, Karlstra\u00dfe 3, 72072 T\u00fcbingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,6,5]]},"reference":[{"key":"ref_1","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. Prim."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1053\/j.jvca.2021.02.053","article-title":"2021 Acute Respiratory Distress Syndrome Update, With Coronavirus Disease 2019 Focus","volume":"36","author":"Welker","year":"2022","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1186\/s13054-020-03240-7","article-title":"Incidence of ARDS and outcomes in hospitalized patients with COVID-19: A global literature survey","volume":"24","author":"Tzotzos","year":"2020","journal-title":"Crit. Care"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1186\/s13054-020-02911-9","article-title":"Acute respiratory failure in COVID-19: Is it \u201ctypical\u201d ARDS?","volume":"24","author":"Li","year":"2020","journal-title":"Crit Care"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Kluge, S., Janssens, U., Welte, T., Weber-Carstens, S., Sch\u00e4lte, G., Spinner, C.D., Malin, J.J., Gastmeier, P., Langer, F., and Wepler, M. (2022). S3-Leitlinie\u2014Empfehlungen zur station\u00e4ren Therapie von Patienten mit COVID-19. Arb. Der Wiss. Med. Fachgesellschaften.","DOI":"10.1055\/a-1334-1925"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Manaker, S. (2023). COVID-19: Management of the Intubated Adult, UpToDate.","DOI":"10.1097\/01.ASM.0000911752.19079.af"},{"key":"ref_7","unstructured":"Panel, C.-T.G. (2023, March 21). Coronavirus Disease 2019 (COVID-19) Treatment Guidelines, Available online: https:\/\/www.covid19treatmentguidelines.nih.gov."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"829771","DOI":"10.3389\/fmed.2022.829771","article-title":"Comparison of COVID-19 Induced Respiratory Failure and Typical ARDS: Similarities and Differences","volume":"9","author":"Lu","year":"2022","journal-title":"Front. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"719166","DOI":"10.3389\/fphys.2021.719166","article-title":"Possible Role of Corollary Discharge in Lack of Dyspnea in Patients With COVID-19 Disease","volume":"12","year":"2021","journal-title":"Front. Physiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1164\/rccm.202005-2025LE","article-title":"COVID-19\u2013versus non\u2013COVID-19\u2013related Acute Respiratory Distress Syndrome: Differences and Similarities","volume":"202","author":"Brault","year":"2020","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.1513\/AnnalsATS.202008-1026OC","article-title":"COVID-19 versus Non-COVID-19 Acute Respiratory Distress Syndrome: Comparison of Demographics, Physiologic Parameters, Inflammatory Biomarkers, and Clinical Outcomes","volume":"18","author":"Bain","year":"2021","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"100518","DOI":"10.1016\/j.eclinm.2020.100518","article-title":"Clinical features, diagnostics, and outcomes of patients presenting with acute respiratory illness: A retrospective cohort study of patients with and without COVID-19","volume":"27","author":"Shah","year":"2020","journal-title":"EClinicalMedicine"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"666629","DOI":"10.3389\/fmed.2021.666629","article-title":"Comparative Study of Acute Lung Injury in COVID-19 and Non-COVID-19 Patients","volume":"8","author":"Zhang","year":"2021","journal-title":"Front. Med."},{"key":"ref_14","first-page":"271","article-title":"The Characteristics of 50 Hospitalized COVID-19 Patients With and Without ARDS","volume":"117","author":"Dreher","year":"2020","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"599533","DOI":"10.3389\/fmed.2020.599533","article-title":"COVID-19 Induced Acute Respiratory Distress Syndrome\u2014A Multicenter Observational Study","volume":"7","author":"Herrmann","year":"2020","journal-title":"Front. Med."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Sagoschen, I., Keller, K., Wild, J., M\u00fcnzel, T., and Hobohm, L. (2022). Case Fatality of Hospitalized Patients with COVID-19 Infection Suffering from Acute Respiratory Distress Syndrome in Germany. Viruses, 14.","DOI":"10.3390\/v14112515"},{"key":"ref_17","unstructured":"Thurau, R.B.J. (2023, February 21). Chronology: How COVID Has Spread in Germany. Available online: https:\/\/www.dw.com\/en\/covid-how-germany-battles-the-pandemic-a-chronology\/a-58026877."},{"key":"ref_18","unstructured":"Robert Koch-Institut (2021). W\u00f6chentlicher Lagebericht des RKI zur Coronavirus-Krankheit-2019 (COVID-19), Robert Koch-Institut."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1007\/s15010-021-01734-2","article-title":"Waves and variants of SARS-CoV-2: Understanding the causes and effect of the COVID-19 catastrophe","volume":"50","author":"Thakur","year":"2022","journal-title":"Infection"},{"key":"ref_20","unstructured":"ARDS Definition Task Force, Ranieri, V.M., Rubenfeld, G.D., Thompson, B.T., Ferguson, N.D., Caldwell, E., Fan, E., Camporota, L., and Slutsky, A.S. (2012). Acute respiratory distress syndrome: The Berlin Definition. JAMA, 307, 2526\u20132533."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation","volume":"40","author":"Charlson","year":"1987","journal-title":"J. Chronic Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1097\/01.mlr.0000182534.19832.83","article-title":"Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data","volume":"43","author":"Quan","year":"2005","journal-title":"Med. Care"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"648","DOI":"10.21105\/joss.00648","article-title":"Comorbidity: An R package for computing comorbidity scores","volume":"3","author":"Gasparini","year":"2018","journal-title":"J. Open Source Softw."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"570","DOI":"10.32614\/RJ-2021-053","article-title":"Reproducible Summary Tables with the gtsummary Package","volume":"13","author":"Sjoberg","year":"2021","journal-title":"R J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"15703","DOI":"10.1038\/s41598-022-19539-0","article-title":"A comparison of impact of comorbidities and demographics on 60-day mortality in ICU patients with COVID-19, sepsis and acute respiratory distress syndrome","volume":"12","author":"Frithiof","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/S0165-1765(03)00032-6","article-title":"Interaction terms in logit and probit models","volume":"1","author":"Ai","year":"2003","journal-title":"Econ. Lett."},{"key":"ref_27","unstructured":"Gordon, M., Lumley, T., and Gordon, M.M. (2019). Package \u2018Forestplot\u2019. Advanced Forest Plot Using \u2018Grid\u2019graphics, The Comprehensive R Archive Network."},{"key":"ref_28","unstructured":"Armstrong, D. (2023, February 14). Package \u2018DAMisc\u2019. Available online: https:\/\/cran.r-project.org\/web\/packages\/DAMisc\/DAMisc.pdf."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"772","DOI":"10.21105\/joss.00772","article-title":"ggeffects: Tidy Data Frames of Marginal Effects from Regression Models","volume":"3","author":"Ldecke","year":"2018","journal-title":"J. Open Source Softw."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1001\/jama.2016.0291","article-title":"Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries","volume":"315","author":"Bellani","year":"2016","journal-title":"JAMA"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1007\/s40620-021-01206-8","article-title":"COVID\u201319 and chronic kidney disease: An updated overview of reviews","volume":"35","author":"Jdiaa","year":"2022","journal-title":"J. Nephrol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"472","DOI":"10.5694\/mja2.50598","article-title":"Consensus statement: Safe Airway Society principles of airway management and tracheal intubation specific to the COVID-19 adult patient group","volume":"212","author":"Brewster","year":"2020","journal-title":"Med. J. Aust."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1002\/emp2.12063","article-title":"Pragmatic recommendations for intubating critically ill patients with suspected COVID-19","volume":"1","author":"Brown","year":"2020","journal-title":"J. Am. Coll. Emerg. Physicians Open"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1111\/anae.15054","article-title":"Consensus guidelines for managing the airway in patients with COVID-19: Guidelines from the Difficult Airway Society, the Association of Anaesthetists the Intensive Care Society, the Faculty of Intensive Care Medicine and the Royal College of Anaesthetists","volume":"75","author":"Cook","year":"2020","journal-title":"Anaesthesia"},{"key":"ref_35","first-page":"105","article-title":"Expert Recommendations for Tracheal Intubation in Critically ill Patients with Noval Coronavirus Disease 2019","volume":"35","author":"Zuo","year":"2020","journal-title":"Chin. Med. Sci. J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1186\/s13054-021-03540-6","article-title":"Effect of timing of intubation on clinical outcomes of critically ill patients with COVID-19: A systematic review and meta-analysis of non-randomized cohort studies","volume":"25","author":"Papoutsi","year":"2021","journal-title":"Crit. Care"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1111\/crj.13361","article-title":"Effectiveness of noninvasive ventilation in COVID-19 related-acute respiratory distress syndrome","volume":"15","author":"Menzella","year":"2021","journal-title":"Clin. Respir. J."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1164\/rccm.202005-2007LE","article-title":"High-Flow Nasal Cannula in Critically III Patients with Severe COVID-19","volume":"202","author":"Demoule","year":"2020","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1055\/s-0034-1393309","article-title":"Nicht-invasive Beatmung als Therapie der akuten respiratorischen Insuffizienz","volume":"69","author":"Westhoff","year":"2015","journal-title":"Pneumo"},{"key":"ref_40","first-page":"154","article-title":"S3-Leitlinie \u201cInvasive Beatmung und Einsatz extrakorporaler Verfahren bei akuter respiratorischer Insuffizienz\u201d","volume":"4","author":"Fichtner","year":"2017","journal-title":"DIVI"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Karagiannidis, C., Hentschker, C., Westhoff, M., Weber-Carstens, S., Janssens, U., Kluge, S., Pfeifer, M., Spies, C., Welte, T., and Rossaint, R. (2022). Observational study of changes in utilization and outcomes in mechanical ventilation in COVID-19. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0262315"},{"key":"ref_42","unstructured":"Irwin, R.S., and Rippe, J.M. (2008). Irwin and Rippe\u2019s Intensive Care Medicine, Lippincott Williams & Wilkins."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s13054-022-04294-5","article-title":"Epidemiology and outcomes of early-onset AKI in COVID-19-related ARDS in comparison with non-COVID-19-related ARDS: Insights from two prospective global cohort studies","volume":"27","author":"McNicholas","year":"2023","journal-title":"Crit. Care"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1876","DOI":"10.1513\/AnnalsATS.202008-1076OC","article-title":"Comparing Clinical Features and Outcomes in Mechanically Ventilated Patients with COVID-19 and Acute Respiratory Distress Syndrome","volume":"18","author":"Sjoding","year":"2021","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1080\/17476348.2020.1804365","article-title":"Mortality in COVID-19 patients with acute respiratory distress syndrome and corticosteroids use: A systematic review and meta-analysis","volume":"14","author":"Hasan","year":"2020","journal-title":"Expert Rev. Respir. Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1932","DOI":"10.1007\/s00134-011-2380-4","article-title":"The ALIEN study: Incidence and outcome of acute respiratory distress syndrome in the era of lung protective ventilation","volume":"37","author":"Villar","year":"2011","journal-title":"Intensive Care Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1080\/17476348.2021.1920927","article-title":"Outcomes of acute respiratory distress syndrome in COVID-19 patients compared to the general population: A systematic review and meta-analysis","volume":"15","author":"Dmytriw","year":"2021","journal-title":"Expert Rev. Respir. Med."}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/15\/6\/1324\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:48:37Z","timestamp":1760125717000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/15\/6\/1324"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,5]]},"references-count":47,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,6]]}},"alternative-id":["v15061324"],"URL":"https:\/\/doi.org\/10.3390\/v15061324","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,5]]}}}