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Clinical sepsis phenotypes in critically ill COVID-19 patients
Critical Care ( IF 15.1 ) Pub Date : 2022-08-09 , DOI: 10.1186/s13054-022-04118-6
Niklas Bruse 1 , Emma J Kooistra 1 , Aron Jansen 1 , Rombout B E van Amstel 2 , Nicolette F de Keizer 3, 4, 5 , Jason N Kennedy 6 , Christopher Seymour 6 , Lonneke A van Vught 2 , Peter Pickkers 1 , Matthijs Kox 1
Affiliation  

A greater understanding of disease heterogeneity may facilitate precision medicine for coronavirus disease 2019 (COVID-19). Previous work identified four distinct clinical phenotypes associated with outcome and treatment responses in non-COVID-19 sepsis patients, but it is unknown if and how these phenotypes are recapitulated in COVID-19 sepsis patients. We applied the four non-COVID-19 sepsis phenotypes to a total of 52,274 critically ill patients, comprising two cohorts of COVID-19 sepsis patients (admitted before and after the introduction of dexamethasone as standard treatment) and three non-COVID-19 sepsis cohorts (non-COVID-19 viral pneumonia sepsis, bacterial pneumonia sepsis, and bacterial sepsis of non-pulmonary origin). Differences in proportions of phenotypes and their associated mortality were determined across these cohorts. Phenotype distribution was highly similar between COVID-19 and non-COVID-19 viral pneumonia sepsis cohorts, whereas the proportion of patients with the δ-phenotype was greater in both bacterial sepsis cohorts compared to the viral sepsis cohorts. The introduction of dexamethasone treatment was associated with an increased proportion of patients with the δ-phenotype (6% vs. 11% in the pre- and post-dexamethasone COVID-19 cohorts, respectively, p < 0.001). Across the cohorts, the α-phenotype was associated with the most favorable outcome, while the δ-phenotype was associated with the highest mortality. Survival of the δ-phenotype was markedly higher following the introduction of dexamethasone (60% vs 41%, p < 0.001), whereas no relevant differences in survival were observed for the other phenotypes among COVID-19 patients. Classification of critically ill COVID-19 patients into clinical phenotypes may aid prognostication, prediction of treatment efficacy, and facilitation of personalized medicine.

中文翻译:

重症 COVID-19 患者的临床败血症表型

对疾病异质性的更深入了解可能有助于 2019 年冠状病毒病 (COVID-19) 的精准医学。以前的工作确定了与非 COVID-19 脓毒症患者的结果和治疗反应相关的四种不同的临床表型,但尚不清楚这些表型是否以及如何在 COVID-19 脓毒症患者中重现。我们将四种非 COVID-19 脓毒症表型应用于总共 52,274 名重症患者,包括两组 COVID-19 脓毒症患者(在引入地塞米松作为标准治疗之前和之后入院)和三名非 COVID-19 脓毒症患者队列(非 COVID-19 病毒性肺炎脓毒症、细菌性肺炎脓毒症和非肺源性细菌性脓毒症)。在这些队列中确定了表型比例及其相关死亡率的差异。COVID-19 和非 COVID-19 病毒性肺炎脓毒症队列之间的表型分布高度相似,而与病毒性脓毒症队列相比,两个细菌性脓毒症队列中具有 δ 表型的患者比例更高。地塞米松治疗的引入与 δ 表型患者比例增加相关(在地塞米松 COVID-19 前后队列中,分别为 6% 和 11%,p < 0.001)。在所有队列中,α-表型与最有利的结果相关,而 δ-表型与最高死亡率相关。在引入地塞米松后,δ-表型的存活率显着提高(60% 对 41%,p < 0.001),而在 COVID-19 患者中,其他表型的存活率未观察到相关差异。
更新日期:2022-08-09
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