Background: The goal of the Berlin ARDS Definition Taskforce was to update the 1994 American-European Consensus Conference (AECC) criteria and, in part, to test its ?predictive validity? for outcomes. The major modification to the AECC was categorizing lung injury severity based upon the ratio of arterial oxygen tension-to inspired oxygen fraction (PaO2/FiO2). Because the focus of the taskforce was pulmonary-related variables, the influence of non-pulmonary variables was not explored. We inquired whether increasing ARDS severity by the Berlin definition coincided with increasing illness severity scores , and whether specific organ dysfunction associated with increased ARDS severity and mortality could be identified on the day of ARDS onset.

Methods: The National Health Insurance(NIH) in Taiwan ARDS quality assurance data base was used; with 2,030 subjects meeting Berlin definition for ARDS between Oct 2020 and May 2021. Subjects were managed with the ARDS Net protocol. Statistical analysis included one-way ANOVA and Fisher Exact tests for mortality.

Results: Mortality, APACHE II and SAPS II scores increased significantly with ARDS severity . Impaired perfusion and renal function increased with ARDS severity. Average urine output was markedly lower than the minimum level deemed adequate (? 2.2 mL/Kg/h) for all categories. Liver function (total bilirubin), hematologic function (platelets) were within normal limits across it. Age was not different (58±13) for all categories, P = 0.82

Conclusion: Mortality, illness severity and comorbidity signifiers increased with AEDS severity. Signifiers of hypotension and hypoperfusion are the most salient signs of organ dysfunction as ARDS severity increases.