Jabaudon M, et al. - Soluble receptor for advanced glycation end-products (sRAGE) is a marker of lung epithelial injury and alveolar fluid clearance (AFC) and, AFC is impaired in most patients with acute respiratory distress syndrome (ARDS) and associated with higher mortality. Consequently, researchers hypothesized that baseline plasma sRAGE would predict mortality, independently of two key mediators of ventilator-induced lung injury. They tested this hypothesis by analyzing eight prospective randomized and observational studies providing relevant individual data for 746 ARDS patients. In these studies published through March 2016, plasma sRAGE was measured in ARDS. They found that independent of driving pressure and tidal volume, higher baseline plasma sRAGE was related to higher 90-day mortality in ARDS patients. This finding strengthened the likely contribution of alveolar epithelial injury as an important prognostic factor in ARDS.