Cardiovascular Subphenotypes in Acute Respiratory Distress Syndrome.

Autor:	Chotalia M; Birmingham Acute Care Research Group, University of Birmingham, Birmingham, United Kingdom.; Department of Anaesthetics and Critical Care, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom., Ali M; Department of Anaesthetics and Critical Care, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom., Alderman JE; Birmingham Acute Care Research Group, University of Birmingham, Birmingham, United Kingdom.; Department of Anaesthetics and Critical Care, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom., Bansal S; Birmingham Acute Care Research Group, University of Birmingham, Birmingham, United Kingdom.; Department of Anaesthetics and Critical Care, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom., Patel JM; Birmingham Acute Care Research Group, University of Birmingham, Birmingham, United Kingdom.; Department of Anaesthetics and Critical Care, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom., Bangash MN; Birmingham Acute Care Research Group, University of Birmingham, Birmingham, United Kingdom.; Department of Anaesthetics and Critical Care, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom., Parekh D; Birmingham Acute Care Research Group, University of Birmingham, Birmingham, United Kingdom.; Department of Anaesthetics and Critical Care, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom.
Jazyk:	angličtina
Zdroj:	Critical care medicine [Crit Care Med] 2023 Apr 01; Vol. 51 (4), pp. 460-470. Date of Electronic Publication: 2023 Jan 06.
DOI:	10.1097/CCM.0000000000005751
Abstrakt:	Objectives: To use clustering methods on transthoracic echocardiography (TTE) findings and hemodynamic parameters to characterize circulatory failure subphenotypes and potentially elucidate underlying mechanisms in patients with acute respiratory distress syndrome (ARDS) and to describe their association with mortality compared with current definitions of right ventricular dysfunction (RVD). Design: Retrospective, single-center cohort study. Setting: University Hospital ICU, Birmingham, United Kingdom. Patients: ICU patients that received TTE within 7 days of ARDS onset between April 2016 and December 2021. Interventions: None. Measurements and Main Results: Latent class analysis (LCA) of TTE/hemodynamic parameters was performed in 801 patients, 62 years old (interquartile range, 50-72 yr old), 63% male, and 40% 90-day mortality rate. Four cardiovascular subphenotypes were identified: class 1 (43%; mostly normal left and right ventricular [LV/RV] function), class 2 (24%; mostly dilated RV with preserved systolic function), class 3 (13%, mostly dilated RV with impaired systolic function), and class 4 (21%; mostly high cardiac output, with hyperdynamic LV function). The four subphenotypes differed in their characteristics and outcomes, with 90-day mortality rates of 19%, 40%, 78%, and 59% in classes 1-4, respectively ( p < 0.0001). Following multivariable logistic regression analysis, class 3 had the highest odds ratio (OR) for mortality (OR, 6.9; 95% CI, 4.0-11.8) compared with other RVD definitions. Different three-variable models had high diagnostic accuracy in identifying each of these latent subphenotypes. Conclusions: LCA of TTE parameters identified four cardiovascular subphenotypes in ARDS that more closely aligned with circulatory failure mechanisms and mortality than current RVD definitions. Competing Interests: Dr. Alderman disclosed that he was funded by the National Institute for Health Research (NIHR) as an academic clinical fellow between 2017 and 2020 and that he was awarded a project grant from the National Institute of Academic Anesthesia in 2018. Dr. Bangash received funding from Gilead Science and Intensive Care Society. Drs. Parekh and Patel received support for article research from Research Councils UK. Dr. Parekh received support for article research from NIHR. The remaining authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)
Databáze:	MEDLINE
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