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Pulmonary ARDS is usually characterized by extensive ground-glass opacification and asymmetric lung consolidation, while extrapulmonary ARDS is characterized by symmetrical ground-glass opacification distributed in perihilar regions ( 2.3 Heterogeneity in the onset time of ARDS The Berlin definition sets the onset of ARDS as within one week of the occurrence or exacerbation of the underlying injury ( 2.4 Biomarker heterogeneity Biomarkers of ARDS can not only indicate the pathogenesis and progression of the disease, but also conduce to identify ARDS subgroups and provide targeted treatment ( In ARDS, RAGE reflects alveolar epithelial damage, whereas Ang-2 is a marker of endothelial cell activation and increased capillary permeability