Clustering COVID-19 ARDS patients through the first days of ICU admission. An analysis of the CIBERESUCICOVID Cohort.

Autor:	Ceccato A; Critical Care Center, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Department of Medicine, Universitat Autonoma de Barcelona, Plaça Torre de L'Aigua, S/N, 08208, Sabadell, Spain. aaceccato@tauli.cat.; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. aaceccato@tauli.cat.; Intensive Care Unit, Hospital Universitari Sagrat Cor, Grupo Quironsalud, Barcelona, Spain. aaceccato@tauli.cat., Forne C; Heorfy Consulting, Lleida, Spain.; Department of Basic Medical Sciences, University of Lleida, Lleida, Spain., Bos LD; Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam UMC Location AMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands., Camprubí-Rimblas M; Critical Care Center, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Department of Medicine, Universitat Autonoma de Barcelona, Plaça Torre de L'Aigua, S/N, 08208, Sabadell, Spain.; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain., Areny-Balagueró A; Critical Care Center, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Department of Medicine, Universitat Autonoma de Barcelona, Plaça Torre de L'Aigua, S/N, 08208, Sabadell, Spain.; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain., Campaña-Duel E; Critical Care Center, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Department of Medicine, Universitat Autonoma de Barcelona, Plaça Torre de L'Aigua, S/N, 08208, Sabadell, Spain.; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain., Quero S; Critical Care Center, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Department of Medicine, Universitat Autonoma de Barcelona, Plaça Torre de L'Aigua, S/N, 08208, Sabadell, Spain.; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain., Diaz E; Critical Care Center, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Department of Medicine, Universitat Autonoma de Barcelona, Plaça Torre de L'Aigua, S/N, 08208, Sabadell, Spain.; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain., Roca O; Critical Care Center, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Department of Medicine, Universitat Autonoma de Barcelona, Plaça Torre de L'Aigua, S/N, 08208, Sabadell, Spain.; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain., De Gonzalo-Calvo D; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.; Translational Research in Respiratory Medicine, Respiratory Department, Hospital Universitari Aranu de Vilanova and Santa Maria, IRBLleida, Lleida, Spain., Fernández-Barat L; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.; Department of Pneumology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, Barcelona, Spain., Motos A; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.; Department of Pneumology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, Barcelona, Spain., Ferrer R; Intensive Care Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Barcelona, Spain., Riera J; Intensive Care Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Barcelona, Spain., Lorente JA; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.; Hospital Universitario de Getafe, Universidad Europea, Madrid, Spain.; Department of Bioengineering, Universidad Carlos III, Madrid, Spain., Peñuelas O; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.; Hospital Universitario de Getafe, Universidad Europea, Madrid, Spain., Menendez R; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.; Pulmonary Department, University and Polytechnic Hospital La Fe, Valencia, Spain., Amaya-Villar R; Intensive Care Clinical Unit, Hospital Universitario Virgen de Rocío, Seville, Spain., Añón JM; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.; Servicio de Medicina Intensiva, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain., Balan-Mariño A; Hospital Universitario San Agustín, Asturias, Spain., Barberà C; Hospital Santa Maria, IRBLleida, Lleida, Spain., Barberán J; Hospital Universitario HM Montepríncipe, Facultad HM Hospitales de Ciencias de La Salud, Universidad Camilo Jose Cela, Madrid, Spain., Blandino-Ortiz A; Servicio de Medicina Intensiva, Hospital Universitario Ramón y Cajal, Madrid, Spain.; Intensive Care Unit, and Emergency Medicine, Universidad de Alcalá, Madrid, Spain., Boado MV; Hospital Universitario de Cruces, Barakaldo, Spain., Bustamante-Munguira E; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.; Department of Intensive Care Medicine, Hospital Clínico Universitario Valladolid, Valladolid, Spain., Caballero J; Critical Intensive Medicine Department, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida, Lleida, Spain., Carbajales C; Intensive Care Unit, Hospital Álvaro Cunqueiro, Vigo, Spain., Carbonell N; Intensive Care Unit, Hospital Clínico Universitario, Valencia, Spain., Catalán-González M; Department of Intensive Care Medicine, Hospital Universitario, 12 de Octubre, Madrid, Spain., Franco N; Hospital Universitario de Móstoles, Madrid, Spain., Galbán C; Department of Critical Care Medicine, CHUS, Complejo Hospitalario Universitario de Santiago, Santiago, Spain., Gumucio-Sanguino VD; Department of Intensive Care, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain., de la Torre MDC; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.; Hospital de Mataró de Barcelona, Barcelona, Spain., Estella Á; Department of Medicine, Intensive Care Unit University Hospital of Jerez, University of Cádiz, INIBiCA, Cádiz, Spain., Gallego E; Unidad de Cuidados Intensivos, Hospital Universitario San Pedro de Alcántara, Cáceres, Spain., García-Garmendia JL; Intensive Care Unit, Hospital San Juan de Dios del Aljarafe, Seville, Spain., Garnacho-Montero J; Intensive Care Clinical Unit, Hospital Universitario Virgen Macarena, Seville, Spain., Gómez JM; Hospital General Universitario Gregorio Marañón, Madrid, Spain., Huerta A; Pulmonary and Critical Care Division, Emergency Department, Clínica Sagrada Família, Barcelona, Spain., Jorge-García RN; Intensive Care Department, Hospital Nuestra Señora de Gracia, Saragossa, Spain., Loza-Vázquez A; Unidad de Medicina Intensiva, Hospital Universitario Virgen de Valme, Seville, Spain., Marin-Corral J; Critical Care Department, Hospital del Mar-IMIM, Barcelona, Spain., Martínez de la Gándara A; Department of Intensive Medicine, Hospital Universitario Infanta Leonor, Madrid, Spain., Martin-Delgado MC; Hospital Universitario Torrejón-Universidad Francisco de Vitoria, Madrid, Spain., Martínez-Varela I; Critical Care Department, Hospital Universitario Lucus Augusti, Lugo, Spain., Messa JL; Complejo Asistencial Universitario de Palencia, Palencia, Spain., Muñiz-Albaiceta G; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.; Departamento de Biología Funcional, Instituto Universitario de Oncología del Principado de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, Hospital Central de Asturias, Universidad de Oviedo, Oviedo, Spain., Nieto MT; Hospital General de Segovia, Segovia, Spain., Novo MA; Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma, Illes Balears, Spain., Peñasco Y; Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain., Pozo-Laderas JC; UGC-Medicina Intensiva, Hospital Universitario Reina Sofia, Instituto Maimonides IMIBIC, Córdoba, Spain., Pérez-García F; Servicio de Microbiología Clínica, Facultad de Medicina, Departamento de Biomedicina y Biotecnología, Hospital Universitario Príncipe de Asturias - Universidad de Alcalá, Alcalá de Henares, Madrid, Spain.; Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain., Ricart P; Servei de Medicina Intensiva, Hospital Universitari Germans Trias, Badalona, Spain., Roche-Campo F; Institut d'Investigació Sanitària Pere Virgili (IISPV), Hospital Verge de la Cinta, Tortosa, Tarragona, Spain., Rodríguez A; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.; Critical Care Department, Hospital Universitario Joan XXIII, CIBERES, Rovira and Virgili University, IISPV, Tarragona, Spain., Sagredo V; Hospital Universitario de Salamanca, Salamanca, Spain., Sánchez-Miralles A; Intensive Care Unit, Hospital Universitario Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, Spain., Sancho-Chinesta S; Servicio de Medicina Intensiva, Hospital Universitario y Politécnico La Fe, Valencia, Spain., Socias L; Intensive Care Unit, Hospital Son Llàtzer, Illes Balears, Palma, Spain., Solé-Violan J; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.; Critical Care Department, Hospital Universitario de GC Dr. Negrín, Universidad Fernando Pessoa Canarias, Las Palmas, Gran Canaria, Spain., Suarez-Sipmann F; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.; Intensive Care Unit, Hospital Universitario La Princesa, Madrid, Spain., Tamayo-Lomas L; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.; Critical Care Department, Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain., Trenado J; Servicio de Medicina Intensiva, Hospital Universitario Mútua de Terrassa, Terrassa, Barcelona, Spain., Úbeda A; Servicio de Medicina Intensiva, Hospital Punta de Europa, Algeciras, Spain., Valdivia LJ; Hospital Universitario de León, León, Spain., Vidal P; Complexo Hospitalario Universitario de Ourense, Orense, Spain., Bermejo J; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.; Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain.; Instituto de Investigación Biomédica de Salamanca (IBSAL), Gerencia Regional de Salud de Castilla y León, Salamanca, Spain., Gonzalez J; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.; Translational Research in Respiratory Medicine, Respiratory Department, Hospital Universitari Aranu de Vilanova and Santa Maria, IRBLleida, Lleida, Spain., Barbe F; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.; Translational Research in Respiratory Medicine, Respiratory Department, Hospital Universitari Aranu de Vilanova and Santa Maria, IRBLleida, Lleida, Spain., Calfee CS; Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA., Artigas A; Critical Care Center, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Department of Medicine, Universitat Autonoma de Barcelona, Plaça Torre de L'Aigua, S/N, 08208, Sabadell, Spain. aartigas@tauli.cat.; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. aartigas@tauli.cat., Torres A; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.; Department of Pneumology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, Barcelona, Spain.
Jazyk:	angličtina
Zdroj:	Critical care (London, England) [Crit Care] 2024 Mar 21; Vol. 28 (1), pp. 91. Date of Electronic Publication: 2024 Mar 21.
DOI:	10.1186/s13054-024-04876-5
Abstrakt:	Background: Acute respiratory distress syndrome (ARDS) can be classified into sub-phenotypes according to different inflammatory/clinical status. Prognostic enrichment was achieved by grouping patients into hypoinflammatory or hyperinflammatory sub-phenotypes, even though the time of analysis may change the classification according to treatment response or disease evolution. We aimed to evaluate when patients can be clustered in more than 1 group, and how they may change the clustering of patients using data of baseline or day 3, and the prognosis of patients according to their evolution by changing or not the cluster. Methods: Multicenter, observational prospective, and retrospective study of patients admitted due to ARDS related to COVID-19 infection in Spain. Patients were grouped according to a clustering mixed-type data algorithm (k-prototypes) using continuous and categorical readily available variables at baseline and day 3. Results: Of 6205 patients, 3743 (60%) were included in the study. According to silhouette analysis, patients were grouped in two clusters. At baseline, 1402 (37%) patients were included in cluster 1 and 2341(63%) in cluster 2. On day 3, 1557(42%) patients were included in cluster 1 and 2086 (57%) in cluster 2. The patients included in cluster 2 were older and more frequently hypertensive and had a higher prevalence of shock, organ dysfunction, inflammatory biomarkers, and worst respiratory indexes at both time points. The 90-day mortality was higher in cluster 2 at both clustering processes (43.8% [n = 1025] versus 27.3% [n = 383] at baseline, and 49% [n = 1023] versus 20.6% [n = 321] on day 3). Four hundred and fifty-eight (33%) patients clustered in the first group were clustered in the second group on day 3. In contrast, 638 (27%) patients clustered in the second group were clustered in the first group on day 3. Conclusions: During the first days, patients can be clustered into two groups and the process of clustering patients may change as they continue to evolve. This means that despite a vast majority of patients remaining in the same cluster, a minority reaching 33% of patients analyzed may be re-categorized into different clusters based on their progress. Such changes can significantly impact their prognosis. (© 2024. The Author(s).)
Databáze:	MEDLINE
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