Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, PR China; Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, PR China; Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, Sichuan University, Chengdu, PR China.
Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, PR China.
J Allergy Clin Immunol Pract. 2021 Feb;9(2):830-841.e14. doi: 10.1016/j.jaip.2020.09.031. Epub 2020 Oct 1.
Hospitalization due to acute asthma exacerbation (AE) is a highly detrimental situation requiring critical management to prevent further deterioration, including mechanical ventilation, intensive care unit (ICU) admission, and death. However, patients hospitalized for AEs are highly heterogeneous and remain largely unexplored.
To identify clinical and inflammatory phenotypes of AE requiring hospitalization associated with in-hospital outcomes.
We performed a hierarchical cluster analysis of 825 consecutively recruited patients hospitalized for AEs. Logistic regressions were conducted to quantify the independent associations of the identified phenotypes with in-hospital outcomes. Decision tree analysis was developed to predict cluster assignment.
We identified 3 clusters of patients, which had significantly different characteristics associated with in-hospital adverse outcomes. Cluster 1 (n = 526, 63.8%) was a late-onset phenotype, cluster 2 (n = 97, 11.8%) was an early-onset phenotype, and cluster 3 (n = 202, 24.5%) was a phenotype with fewer eosinophils and more comorbidities. Clusters 2 and 3 had an elevated risk of death (relative ratio [RR], 18.10 and 19.17, respectively) and mechanical ventilation (RR, 2.56 and 5.71, respectively) than did cluster 1. Individuals in cluster 3 had an extended length of hospital stay (11 days), increased hospitalization direct costs (13,481.57 Chinese Yuan), and a higher risk of ICU admission (RR, 2.14) than individuals in clusters 1 and 2. The decision tree assigned 90.8% of the participants correctly.
We identified 3 phenotypes with differential clinical and inflammatory characteristics associated with in-hospital adverse outcomes. These new phenotypes might have important and clinically relevant implications for the management of patients hospitalized for AEs.
因急性哮喘加重（AE）而住院是一种极具危害性的情况，需要进行关键的管理以防止病情进一步恶化，包括机械通气、重症监护病房（ICU）入院和死亡。然而，因 AE 住院的患者高度异质，且在很大程度上仍未得到充分探索。
确定与住院期间结局相关的需要住院治疗的 AE 的临床和炎症表型。
我们对 825 例连续招募的因 AE 住院的患者进行了分层聚类分析。进行逻辑回归以量化所确定的表型与住院期间结局的独立关联。开发决策树分析以预测聚类分配。
我们确定了 3 组患者，这些患者具有明显不同的特征，与住院期间不良结局相关。第 1 组（n=526，63.8%）为迟发型表型，第 2 组（n=97，11.8%）为早发型表型，第 3 组（n=202，24.5%）为嗜酸性粒细胞较少且合并症较多的表型。第 2 组和第 3 组的死亡风险（相对比[RR]，分别为 18.10 和 19.17）和机械通气风险（RR，分别为 2.56 和 5.71）均高于第 1 组。第 3 组的个体住院时间延长（11 天）、住院直接费用增加（13481.57 元人民币）和 ICU 入院风险升高（RR，2.14），均高于第 1 组和第 2 组。决策树正确分配了 90.8%的参与者。
我们确定了 3 种具有不同临床和炎症特征的表型，这些表型与住院期间不良结局相关。这些新表型可能对管理因 AE 住院的患者具有重要且具有临床相关性的意义。
