Further, end-stage liver disease (ESLD) is known to be a barrier to ARDS resolution[19] and impairs inactivation of inflammatory mediators during sepsis leading to sustained elevation in IL-6 and IL-8.[20, 21] Both these factors may explain the higher prevalence of ESLD in the Hyperinflammatory subphenotype. This evidence concerns the gene IL6 and acute respiratory distress syndrome.