Association Between Angiopoietin-2 and Multiorgan Dysfunction in ARDS Over Time

Sunday, March 22, 2026

2:45 PM - 3:45 PM Central Time

Location: Connections Central Theater 1

Sara J. Olney, BSN (she/her/hers)

Disclosure(s): No relevant financial relationship(s) to disclose.
AS

Alexis Serra, MD, MPH

New York University

Disclosure(s): No relevant financial relationship(s) to disclose.
Mona Patel, PharmD, FCCM, BCCCP (she/her/hers)

NYU Langone Health, New York

Disclosure(s): No relevant financial relationship(s) to disclose.
Ivan Garcia, RRT

Director of Respiratory Care Research
New York University Grossman School of Medicine

Disclosure(s): Calcimedica: Contracted Research (Ongoing); nih/nhlbi: Grant/Research Support (Ongoing); Regeneron: Contracted Research (Ongoing); Sedana Medical: Contracted Research (Ongoing)
JB

Jeremy Beitler, MD, MPH

New York University

Disclosure(s): Calcimedica: Clinical Trial Investigator (Ongoing), University Grants/Research Support (Ongoing); Mezzion: Consultant (Terminated, January 4, 2024); Regeneron: Clinical Trial Investigator (Ongoing), University Grants/Research Support (Ongoing); Sedana Medical: Clinical Trial Investigator (Ongoing), University Grants/Research Support (Ongoing)

Introduction: Endothelial injury is a key component of disease severity in acute respiratory distress syndrome (ARDS). Angiopoietin-2 (Ang2) is a protein biomarker of endothelium injury and mediator of vascular permeability. Higher plasma Ang2 concentration is associated with worse clinical outcomes in patients with ARDS. Whether changes in Ang2 in individual patients over time provide additional prognostic information is unknown.

Methods: This prospective two-hospital cohort study enrolled adults with ARDS admitted to the ICU within 4 days of initiating invasive mechanical ventilation. Illness severity was assessed using APACHE II at enrollment and daily Sequential Organ Failure Assessment (SOFA) scores. Plasma was collected at enrollment and every 12±4 hours for 72 hours or until extubation. Linear regression was used to evaluate the association between baseline Ang2 and illness severity markers. The relationship of Ang2 with SOFA over time was assessed using linear mixed models with random intercepts. Logistic regression models were used to evaluate the association between baseline and change in Ang2 with 28-day mortality. Ang2 was entered on the log scale in all analyses. Statistical significance was set at p< 0.05.

Results: The study included 72 patients (62% female) with a mean age of 56±15 years. The mean APACHE II score was 35±6, and the mean SOFA score was 12±3. The mean PaO₂:FiO₂ ratio was 106±54. Of the cohort, 51 patients (71%) required vasopressors. In baseline cross-sectional analysis, higher Ang2 was significantly associated with higher SOFA, worsening shock, and lower PaO₂:FiO₂ in separate unadjusted models. Rising Ang2 over time correlated with worsening organ dysfunction as measured by daily SOFA scores (β = 0.76, 95%CI 0.25–1.28; p< 0.01). Ang2 at enrollment was not correlated with 28-day mortality. However, increasing Ang2 over the first 72 hours predicted 28-day mortality in unadjusted analysis (OR 3.11, 95%CI 1.22–7.97; p=0.02) and after adjustment for APACHE II and ARDS severity (OR 3.01, 95%CI 1.18–7.70; p=0.02).

Conclusions: Within patient changes in Ang2 over the first 72 hours is associated with worsening organ dysfunction and predicts subsequent mortality in ARDS patients, independent of severity of illness.