tetano
Editor, Senior Moderator
Infect Dis Ther
. 2026 Jan 6.
doi: 10.1007/s40121-025-01291-3. Online ahead of print. Clinical Phenotypes of Critically Ill Patients with COVID-19 Infected with Omicron: A Nationwide Prospective Cohort Study
Etienne Audureau[SUP] #[/SUP][SUP] 1 2 3 [/SUP], Pierre Bay[SUP] #[/SUP][SUP] 4 5 6 [/SUP], Sébastien Préau[SUP] 7 [/SUP], Raphaël Favory[SUP] 7 [/SUP], Aurélie Guigon[SUP] 8 [/SUP], Nicholas Heming[SUP] 9 [/SUP], Elyanne Gault[SUP] 10 [/SUP], Tài Pham[SUP] 11 12 13 [/SUP], Amal Chaghouri[SUP] 14 [/SUP], Matthieu Turpin[SUP] 15 [/SUP], Laurence Morand-Joubert[SUP] 16 17 [/SUP], Sébastien Jochmans[SUP] 18 [/SUP], Aurélia Pitsch[SUP] 19 [/SUP], Sylvie Meireles[SUP] 20 [/SUP], Damien Contou[SUP] 21 [/SUP], Amandine Henry[SUP] 22 [/SUP], Damien Roux[SUP] 23 24 [/SUP], Quentin Le Hingrat[SUP] 25 [/SUP], Antoine Kimmoun[SUP] 26 27 [/SUP], Cédric Hartard[SUP] 28 29 [/SUP], Frédéric Pène[SUP] 30 [/SUP], Anne-Sophie L'Honneur[SUP] 31 [/SUP], Antoine Guillon[SUP] 32 [/SUP], Lynda Handala[SUP] 33 34 [/SUP], Fabienne Tamion[SUP] 35 [/SUP], Alice Moisan[SUP] 36 [/SUP], Thomas Daix[SUP] 37 [/SUP], Sébastien Hantz[SUP] 38 39 [/SUP], Flora Delamaire[SUP] 40 [/SUP], Vincent Thibault[SUP] 41 42 [/SUP], Cédric Darreau[SUP] 43 [/SUP], Jean Thomin[SUP] 44 [/SUP], Jean-Michel Pawlotsky[SUP] 11 45 46 [/SUP], Slim Fourati[SUP] #[/SUP][SUP] 11 45 46 [/SUP], Nicolas de Prost[SUP] #[/SUP][SUP] 1 47 11 45 [/SUP]; SEVARVIR investigators
Collaborators, Affiliations
Introduction: The clinical presentation of critically ill patients with coronavirus disease 2019 (COVID-19) has evolved significantly with the emergence of the Omicron variant. Current intensive care unit (ICU) admissions involve patients with diverse comorbidities and immune statuses, highlighting the need to redefine homogeneous phenotypic subgroups within this population. This study aimed to characterize distinct clinical phenotypes among critically ill patients with COVID-19 and acute respiratory failure.
Methods: This multicenter prospective substudy of the SEVARVIR cohort included adult patients from 39 French ICUs between December 2021 and October 2024 with acute respiratory failure and infected with the Omicron variant. Clustering analysis was conducted using Kohonen's self-organizing maps (SOMs) and validated with ClinTrajan, two unsupervised clustering methods, to identify homogeneous patient phenotypes.
Results: During the study period, 777 patients with Omicron infection were included, and 7 distinct clinical clusters were identified. Clusters 1 and 2 included patients with metabolic and cardiovascular comorbidities. Cluster 3 featured younger, mildly ill patients with isolated chronic respiratory failure, while cluster 4 comprised older male patients with isolated respiratory failure. Cluster 5 included patients with isolated hematologic malignancies, cluster 6 patients with multiorgan failure, and cluster 7 organ transplant recipients, with high severity scores and impaired renal function. ICU management varied substantially across clusters. Patients in clusters 5 and 7 had the highest requirements for organ support, with frequent use of invasive mechanical ventilation, vasopressors (cluster 6), and renal replacement therapy (cluster 7). Dexamethasone and tocilizumab were most commonly prescribed in cluster 4 (91.3% and 30.2%, respectively). Mortality at day 28 varied significantly across clusters, ranging from 13.1% in cluster 3 to 41.1% in cluster 6.
Conclusions: This clustering analysis highlights, for the first time, the clinical heterogeneity of critically ill patients infected with Omicron, identifying seven distinct clusters with varying clinical presentations, management strategies and outcomes. These findings underscore the relevance of a phenotype-driven approach to support personalized treatment strategies and guide future clinical trials.
Trial registration: Clinicaltrials.gov, NCT05162508. A Graphical Abstract is available for this article.
Keywords: Acute respiratory distress syndrome; Acute respiratory failure; COVID-19; Intensive care unit; Omicron; Precision medicine; SARS-CoV-2.
. 2026 Jan 6.
doi: 10.1007/s40121-025-01291-3. Online ahead of print. Clinical Phenotypes of Critically Ill Patients with COVID-19 Infected with Omicron: A Nationwide Prospective Cohort Study
Etienne Audureau[SUP] #[/SUP][SUP] 1 2 3 [/SUP], Pierre Bay[SUP] #[/SUP][SUP] 4 5 6 [/SUP], Sébastien Préau[SUP] 7 [/SUP], Raphaël Favory[SUP] 7 [/SUP], Aurélie Guigon[SUP] 8 [/SUP], Nicholas Heming[SUP] 9 [/SUP], Elyanne Gault[SUP] 10 [/SUP], Tài Pham[SUP] 11 12 13 [/SUP], Amal Chaghouri[SUP] 14 [/SUP], Matthieu Turpin[SUP] 15 [/SUP], Laurence Morand-Joubert[SUP] 16 17 [/SUP], Sébastien Jochmans[SUP] 18 [/SUP], Aurélia Pitsch[SUP] 19 [/SUP], Sylvie Meireles[SUP] 20 [/SUP], Damien Contou[SUP] 21 [/SUP], Amandine Henry[SUP] 22 [/SUP], Damien Roux[SUP] 23 24 [/SUP], Quentin Le Hingrat[SUP] 25 [/SUP], Antoine Kimmoun[SUP] 26 27 [/SUP], Cédric Hartard[SUP] 28 29 [/SUP], Frédéric Pène[SUP] 30 [/SUP], Anne-Sophie L'Honneur[SUP] 31 [/SUP], Antoine Guillon[SUP] 32 [/SUP], Lynda Handala[SUP] 33 34 [/SUP], Fabienne Tamion[SUP] 35 [/SUP], Alice Moisan[SUP] 36 [/SUP], Thomas Daix[SUP] 37 [/SUP], Sébastien Hantz[SUP] 38 39 [/SUP], Flora Delamaire[SUP] 40 [/SUP], Vincent Thibault[SUP] 41 42 [/SUP], Cédric Darreau[SUP] 43 [/SUP], Jean Thomin[SUP] 44 [/SUP], Jean-Michel Pawlotsky[SUP] 11 45 46 [/SUP], Slim Fourati[SUP] #[/SUP][SUP] 11 45 46 [/SUP], Nicolas de Prost[SUP] #[/SUP][SUP] 1 47 11 45 [/SUP]; SEVARVIR investigators
Collaborators, Affiliations
- PMID: 41493514
- DOI: 10.1007/s40121-025-01291-3
Introduction: The clinical presentation of critically ill patients with coronavirus disease 2019 (COVID-19) has evolved significantly with the emergence of the Omicron variant. Current intensive care unit (ICU) admissions involve patients with diverse comorbidities and immune statuses, highlighting the need to redefine homogeneous phenotypic subgroups within this population. This study aimed to characterize distinct clinical phenotypes among critically ill patients with COVID-19 and acute respiratory failure.
Methods: This multicenter prospective substudy of the SEVARVIR cohort included adult patients from 39 French ICUs between December 2021 and October 2024 with acute respiratory failure and infected with the Omicron variant. Clustering analysis was conducted using Kohonen's self-organizing maps (SOMs) and validated with ClinTrajan, two unsupervised clustering methods, to identify homogeneous patient phenotypes.
Results: During the study period, 777 patients with Omicron infection were included, and 7 distinct clinical clusters were identified. Clusters 1 and 2 included patients with metabolic and cardiovascular comorbidities. Cluster 3 featured younger, mildly ill patients with isolated chronic respiratory failure, while cluster 4 comprised older male patients with isolated respiratory failure. Cluster 5 included patients with isolated hematologic malignancies, cluster 6 patients with multiorgan failure, and cluster 7 organ transplant recipients, with high severity scores and impaired renal function. ICU management varied substantially across clusters. Patients in clusters 5 and 7 had the highest requirements for organ support, with frequent use of invasive mechanical ventilation, vasopressors (cluster 6), and renal replacement therapy (cluster 7). Dexamethasone and tocilizumab were most commonly prescribed in cluster 4 (91.3% and 30.2%, respectively). Mortality at day 28 varied significantly across clusters, ranging from 13.1% in cluster 3 to 41.1% in cluster 6.
Conclusions: This clustering analysis highlights, for the first time, the clinical heterogeneity of critically ill patients infected with Omicron, identifying seven distinct clusters with varying clinical presentations, management strategies and outcomes. These findings underscore the relevance of a phenotype-driven approach to support personalized treatment strategies and guide future clinical trials.
Trial registration: Clinicaltrials.gov, NCT05162508. A Graphical Abstract is available for this article.
Keywords: Acute respiratory distress syndrome; Acute respiratory failure; COVID-19; Intensive care unit; Omicron; Precision medicine; SARS-CoV-2.