ESM1 and acute respiratory distress syndrome: Members of our group have shown that angiopoietin 2 to angiopoietin 1 ratio, VCAM-1, and von Willebrand factor could discriminate between direct and indirect lung injury in pediatric sepsis.9 Patients with indirect or extrapulmonary sepsis meeting criteria for ARDS had elevated levels of angiopoietin 2, angiopoietin 2 to angiopoietin 1 ratio, von Willebrand factor, and endocan relative to those without ARDS and were associated with higher rates of a complicated course.26