Identifying Clinical Phenotypes in Moderate to Severe Acute Respiratory Distress Syndrome Related to COVID-19: The COVADIS Study.

Autor:	Lascarrou JB; Médecine Intensive Reanimation, CHU Nantes, Nantes Cedex, France., Gaultier A; Plateforme de Méthodologie et Biostatistique, CHU Nantes, Nantes Cedex, France., Soumagne T; Médecine Intensive Réanimation, CHU Besançon, Besançon, France., Serck N; Unité de Soins Intensifs Clinique Saint Pierre, Ottignies, Belgium., Sauneuf B; Réanimation - Médecine Intensive, Centre Hospitalier Public du Cotentin, BP208, Cherbourg-en-Cotentin, France., Piagnerelli M; Intensive Care, Centre Hospitalier Universitaire-Charleroi, Marie Curie, Université Libre de Bruxelles, Charleroi, Belgium., Ly A; Service D'anesthésie-Réanimation Chirurgicale Unité de Réanimation Chirurgicale Polyvalente Hôpitaux Universitaires Henri Mondor, Créteil, France., Lejeune F; Unité de Soins Intensifs Clinique Notre Dame de Grâce, Gosselies, Belgium., Lefebvre L; Réanimation Polyvalente Center Hospitalier du Pays d'Aix, Aix en Provence, France., Hraiech S; Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France.; Centre d'Etudes et de Recherches sur les Services de Santé et Qualité de vie EA 3279, Aix- Faculté de médecine, Marseille Université, Marseille, France., Horlait G; Unité de Soins Intensifs, Centre Hospitalier Universitaire Dinant Godinne, Site Godinne, Yvoir, Belgium., Higny J; Unité de Soins Intensifs, Centre Hospitalier Universitaire Dinant Godinne, Site Dinant, Dinant, Belgium., D'hondt A; Unité de Soins Intensifs, Centre Hospitalier Universitaire Ambroise Paré, Mons, Belgium., Gaudry S; Réanimation Médico-Chirurgicale CHU Avicennes, Université Sorbonne Paris Nord, Bobigny, France., Courcelle R; Unité de Soins Intensifs, Centres Hospitaliers de Jolimont, La Louvière, Belgium., Carbutti G; Unité de Soins Intensifs, Centre Hospitalier Regional Mons-Hainaut, Mons, Belgium., Blonz G; Médecine Intensive Réanimation, Center Hospitalier Départmental, Boulevard Stephane Moreau, La Roche Sur Yon, France., Ottavy G; Médecine Intensive Reanimation, CHU Nantes, Nantes Cedex, France., Aissaoui N; Médecine Intensive Réanimation, Hôpital Européen Georges Pompidou, Université de Paris, Paris Centre U 970 PARCC, Paris, France., Vinsonneau C; Service de Médecine Intensive Réanimation Unité de Sevrage Ventilatoire et Réhabilitation Center Hospitalier de BETHUNE, Beuvry, France., Vandenbunder B; Groupe des Anesthésistes Réanimateurs, Hôpital Privé d'Antony, Antony, France., Textoris J; Service de Réanimation, Hospices Civils de Lyon, Lyon, France.; Laboratoire de Recherche bioMérieux-Hospices Civils de Lyon-Université de Lyon 1, Lyon, France., Szychowiak P; Médecine Intensive Reanimation, CHRU Tours, Tours, France.; INSERM CIC 1415, CHRU Tours, Tours, France.; CRICS-TriggerSEP Research Network, Tours, France., Grimaldi D; Soins Intensifs, Hôpital Erasme, Universite Libre Bruxelles, Bruxelles, Belgium.
Jazyk:	angličtina
Zdroj:	Frontiers in medicine [Front Med (Lausanne)] 2021 Mar 11; Vol. 8, pp. 632933. Date of Electronic Publication: 2021 Mar 11 (Print Publication: 2021).
DOI:	10.3389/fmed.2021.632933
Abstrakt:	Objectives: Different phenotypes have been identified in acute respiratory distress syndrome (ARDS). Existence of several phenotypes in coronavirus disease (COVID-19) related acute respiratory distress syndrome is unknown. We sought to identify different phenotypes of patients with moderate to severe ARDS related to COVID-19. Methods: We conducted an observational study of 416 COVID-19 patients with moderate to severe ARDS at 21 intensive care units in Belgium and France. The primary outcome was day-28 ventilatory free days. Secondary outcomes were mortality on day 28, acute kidney injury, acute cardiac injury, pulmonary embolism, and deep venous thrombosis. Multiple factor analysis and hierarchical classification on principal components were performed to distinguish different clinical phenotypes. Results: We identified three different phenotypes in 150, 176, and 90 patients, respectively. Phenotype 3 was characterized by short evolution, severe hypoxemia, and old comorbid patients. Phenotype 1 was mainly characterized by the absence of comorbidities, relatively high compliance, and long duration of symptoms, whereas phenotype 2 was characterized female sex, and the presence of mild comorbidities such as uncomplicated diabetes or chronic hypertension. The compliance in phenotype 2 was lower than that in phenotype 1, with higher plateau and driving pressure. Phenotype 3 was associated with higher mortality compared to phenotypes 1 and 2. Conclusions: In COVID-19 patients with moderate to severe ARDS, we identified three clinical phenotypes. One of these included older people with comorbidities who had a fulminant course of disease with poor prognosis. Requirement of different treatments and ventilatory strategies for each phenotype needs further investigation. Competing Interests: JT is a part-time employee of bioMérieux, an IVD company, and Hospices Civils de Lyon, a university hospital. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2021 Lascarrou, Gaultier, Soumagne, Serck, Sauneuf, Piagnerelli, Ly, Lejeune, Lefebvre, Hraiech, Horlait, Higny, D'hondt, Gaudry, Courcelle, Carbutti, Blonz, Ottavy, Aissaoui, Vinsonneau, Vandenbunder, Textoris, Szychowiak, Grimaldi and the COVADIS study group.)
Databáze:	MEDLINE
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