Identification of novel sub-phenotypes of severe ARDS requiring ECMO using latent class analysis.

Autor: Nishikimi M; Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan. m0528332626@yahoo.co.jp., Ohshimo S; Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan., Bellani G; Centre for Medical Sciences-CISMed, University of Trento, Trento, Italy.; Department of Anesthesia and Intensive Care, Santa Chiara Hospital, APSS Trento Largo Medaglie d'Oro Trento, Trento, Italy., Fukumoto W; Department of Diagnostic Radiology, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan., Anzai T; M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan., Liu K; Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.; Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia.; Non-Profit Organization ICU Collaboration Network (ICON), Tokyo, Japan., Ishii J; Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan., Kyo M; Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan., Awai K; Department of Diagnostic Radiology, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan., Takahashi K; M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan., Shime N; Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
Jazyk: angličtina
Zdroj: Critical care (London, England) [Crit Care] 2024 Oct 24; Vol. 28 (1), pp. 343. Date of Electronic Publication: 2024 Oct 24.
DOI: 10.1186/s13054-024-05143-3
Abstrakt: Background: Sub-phenotyping of acute respiratory distress syndrome (ARDS) could be useful for evaluating the severity of ARDS or predicting its responsiveness to given therapeutic strategies, but no studies have yet investigated the heterogeneity of patients with severe ARDS requiring veno-venous extracorporeal membrane oxygenation (V-V ECMO).
Methods: We conducted this retrospective multicenter observational study in adult patients with severe ARDS treated by V-V ECMO. We performed latent class analysis (LCA) for identifying sub-phenotypes of severe ARDS based on the radiological and clinical findings at the start of ECMO support. Multivariate Cox regression analysis was conducted to investigate the differences in mortality and association between the PEEP setting of ≥ 10 cmH 2 O and mortality by the sub-phenotypes.
Results: We identified three sub-phenotypes from analysis of the data of a total of 544 patients with severe ARDS treated by V-V ECMO, as follows: Dry type (n = 185; 34%); Wet type (n = 169; 31%); and Fibrotic type (n = 190; 35%). The 90-days in-hospital mortality risk was higher in the patients with the Fibrotic type than in those with the Dry type (adjusted hazard ratio [95% confidence interval] 1.75 [1.10-2.79], p = 0.019) or the Wet type (1.50 [1.02-2.23], p = 0.042). The PEEP setting of ≥ 10 cmH 2 O during the first 3 days of ECMO decreased the 90-days in-hospital mortality risk only in patients with the Wet type, and not in those with the Dry or Fibrotic type. A significant interaction effect was observed between the Wet type and the PEEP setting of ≥ 10 cmH 2 O in relation to the 90-day in-hospital mortality (p interaction  = 0.036).
Conclusions: The three sub-phenotypes showed different mortality rates and different relationships between higher PEEP settings in the early phase of V-V ECMO and patient outcomes. Our data suggest that we may need to change our management approach to patients with severe ARDS during V-V ECMO according to their clinical sub-phenotype.
(© 2024. The Author(s).)
Databáze: MEDLINE
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