Lascarrou Jean-Baptiste, Gaultier Aurelie, Soumagne Thibaud, Serck Nicolas, Sauneuf Bertrand, Piagnerelli Michael, Ly Andre, Lejeune Francois, Lefebvre Laurent, Hraiech Sami, Horlait Geoffrey, Higny Julien, D'hondt Alain, Gaudry Stephane, Courcelle Romain, Carbutti Giuseppe, Blonz Gauthier, Ottavy Gregoire, Aissaoui Nadia, Vinsonneau Christophe, Vandenbunder Benoit, Textoris Julien, Szychowiak Piotr, Grimaldi David
Médecine Intensive Reanimation, CHU Nantes, Nantes Cedex, France.
Plateforme de Méthodologie et Biostatistique, CHU Nantes, Nantes Cedex, France.
Front Med (Lausanne). 2021 Mar 11;8:632933. doi: 10.3389/fmed.2021.632933. eCollection 2021.
Different phenotypes have been identified in acute respiratory distress syndrome (ARDS). Existence of several phenotypes in coronavirus disease (COVID-19) related acute respiratory distress syndrome is unknown. We sought to identify different phenotypes of patients with moderate to severe ARDS related to COVID-19. We conducted an observational study of 416 COVID-19 patients with moderate to severe ARDS at 21 intensive care units in Belgium and France. The primary outcome was day-28 ventilatory free days. Secondary outcomes were mortality on day 28, acute kidney injury, acute cardiac injury, pulmonary embolism, and deep venous thrombosis. Multiple factor analysis and hierarchical classification on principal components were performed to distinguish different clinical phenotypes. We identified three different phenotypes in 150, 176, and 90 patients, respectively. Phenotype 3 was characterized by short evolution, severe hypoxemia, and old comorbid patients. Phenotype 1 was mainly characterized by the absence of comorbidities, relatively high compliance, and long duration of symptoms, whereas phenotype 2 was characterized female sex, and the presence of mild comorbidities such as uncomplicated diabetes or chronic hypertension. The compliance in phenotype 2 was lower than that in phenotype 1, with higher plateau and driving pressure. Phenotype 3 was associated with higher mortality compared to phenotypes 1 and 2. In COVID-19 patients with moderate to severe ARDS, we identified three clinical phenotypes. One of these included older people with comorbidities who had a fulminant course of disease with poor prognosis. Requirement of different treatments and ventilatory strategies for each phenotype needs further investigation.
在急性呼吸窘迫综合征（ARDS）中已鉴定出不同的表型。冠状病毒病（COVID-19）相关急性呼吸窘迫综合征中几种表型的存在情况尚不清楚。我们试图鉴定与COVID-19相关的中度至重度ARDS患者的不同表型。我们在比利时和法国的21个重症监护病房对416例中度至重度ARDS的COVID-19患者进行了一项观察性研究。主要结局是第28天无通气天数。次要结局是第28天的死亡率、急性肾损伤、急性心脏损伤、肺栓塞和深静脉血栓形成。进行多因素分析和主成分分层分类以区分不同的临床表型。我们分别在150例、176例和90例患者中鉴定出三种不同的表型。表型3的特征是病程短、严重低氧血症和老年合并症患者。表型1主要特征是无合并症、相对较高的顺应性和症状持续时间长，而表型2的特征是女性以及存在轻度合并症，如单纯性糖尿病或慢性高血压。表型2的顺应性低于表型1，平台压和驱动压更高。与表型1和2相比，表型3的死亡率更高。在中度至重度ARDS的COVID-19患者中，我们鉴定出三种临床表型。其中一种包括患有合并症的老年人，他们病程凶险，预后较差。每种表型对不同治疗和通气策略的需求需要进一步研究。
