tetano
Editor, Senior Moderator
EClinicalMedicine
. 2021 Apr 15;100829.
doi: 10.1016/j.eclinm.2021.100829. Online ahead of print.
Identifying clinical and biochemical phenotypes in acute respiratory distress syndrome secondary to coronavirus disease-2019
Sylvia Ranjeva[SUP] 1 [/SUP], Riccardo Pinciroli[SUP] 1 [/SUP], Evan Hodell[SUP] 1 [/SUP], Ariel Mueller[SUP] 1 [/SUP], C Corey Hardin[SUP] 2 [/SUP], B Taylor Thompson[SUP] 2 [/SUP], Lorenzo Berra[SUP] 1 [/SUP]
Affiliations
Abstract
Background: Acute respiratory distress syndrome (ARDS) secondary to coronavirus disease-2019 (COVID-19) is characterized by substantial heterogeneity in clinical, biochemical, and physiological characteristics. However, the pathophysiology of severe COVID-19 infection is poorly understood. Previous studies established clinical and biological phenotypes among classical ARDS cohorts, with important therapeutic implications. The phenotypic profile of COVID-19 associated ARDS remains unknown.
Methods: We used latent class modeling via a multivariate mixture model to identify phenotypes from clinical and biochemical data collected from 263 patients admitted to Massachusetts General Hospital intensive care unit with COVID-19-associated ARDS between March 13 and August 2, 2020.
Findings: We identified two distinct phenotypes of COVID-19-associated ARDS, with substantial differences in biochemical profiles despite minimal differences in respiratory dynamics. The minority phenotype (class 2, n = 70, 26?6%) demonstrated increased markers of coagulopathy, with mild relative hyper-inflammation and dramatically increased markers of end-organ dysfunction (e.g., creatinine, troponin). The odds of 28-day mortality among the class 2 phenotype was more than double that of the class 1 phenotype (40?0% vs.? 23?3%, OR = 2?2, 95% CI [1?2, 3?9]).
Interpretation: We identified distinct phenotypic profiles in COVID-19 associated ARDS, with little variation according to respiratory physiology but with important variation according to systemic and extra-pulmonary markers. Phenotypic identity was highly associated with short-term mortality. The class 2 phenotype exhibited prominent signatures of coagulopathy, suggesting that vascular dysfunction may play an important role in the clinical progression of severe COVID-19-related disease.
Keywords: ARDS; COVID-19; Phenotypes; Statistical inference.
. 2021 Apr 15;100829.
doi: 10.1016/j.eclinm.2021.100829. Online ahead of print.
Identifying clinical and biochemical phenotypes in acute respiratory distress syndrome secondary to coronavirus disease-2019
Sylvia Ranjeva[SUP] 1 [/SUP], Riccardo Pinciroli[SUP] 1 [/SUP], Evan Hodell[SUP] 1 [/SUP], Ariel Mueller[SUP] 1 [/SUP], C Corey Hardin[SUP] 2 [/SUP], B Taylor Thompson[SUP] 2 [/SUP], Lorenzo Berra[SUP] 1 [/SUP]
Affiliations
- PMID: 33875978
- PMCID: PMC8047387
- DOI: 10.1016/j.eclinm.2021.100829
Abstract
Background: Acute respiratory distress syndrome (ARDS) secondary to coronavirus disease-2019 (COVID-19) is characterized by substantial heterogeneity in clinical, biochemical, and physiological characteristics. However, the pathophysiology of severe COVID-19 infection is poorly understood. Previous studies established clinical and biological phenotypes among classical ARDS cohorts, with important therapeutic implications. The phenotypic profile of COVID-19 associated ARDS remains unknown.
Methods: We used latent class modeling via a multivariate mixture model to identify phenotypes from clinical and biochemical data collected from 263 patients admitted to Massachusetts General Hospital intensive care unit with COVID-19-associated ARDS between March 13 and August 2, 2020.
Findings: We identified two distinct phenotypes of COVID-19-associated ARDS, with substantial differences in biochemical profiles despite minimal differences in respiratory dynamics. The minority phenotype (class 2, n = 70, 26?6%) demonstrated increased markers of coagulopathy, with mild relative hyper-inflammation and dramatically increased markers of end-organ dysfunction (e.g., creatinine, troponin). The odds of 28-day mortality among the class 2 phenotype was more than double that of the class 1 phenotype (40?0% vs.? 23?3%, OR = 2?2, 95% CI [1?2, 3?9]).
Interpretation: We identified distinct phenotypic profiles in COVID-19 associated ARDS, with little variation according to respiratory physiology but with important variation according to systemic and extra-pulmonary markers. Phenotypic identity was highly associated with short-term mortality. The class 2 phenotype exhibited prominent signatures of coagulopathy, suggesting that vascular dysfunction may play an important role in the clinical progression of severe COVID-19-related disease.
Keywords: ARDS; COVID-19; Phenotypes; Statistical inference.