Birmingham Acute Care Research Group, University of Birmingham, Birmingham, United Kingdom.
Department of Anaesthetics and Critical Care, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom.
Crit Care Med. 2023 Apr 1;51(4):460-470. doi: 10.1097/CCM.0000000000005751. Epub 2023 Jan 6.
To use clustering methods on transthoracic echocardiography (TTE) findings and hemodynamic parameters to characterize circulatory failure subphenotypes and potentially elucidate underlying mechanisms in patients with acute respiratory distress syndrome (ARDS) and to describe their association with mortality compared with current definitions of right ventricular dysfunction (RVD).
Retrospective, single-center cohort study.
University Hospital ICU, Birmingham, United Kingdom.
ICU patients that received TTE within 7 days of ARDS onset between April 2016 and December 2021.
None.
Latent class analysis (LCA) of TTE/hemodynamic parameters was performed in 801 patients, 62 years old (interquartile range, 50-72 yr old), 63% male, and 40% 90-day mortality rate. Four cardiovascular subphenotypes were identified: class 1 (43%; mostly normal left and right ventricular [LV/RV] function), class 2 (24%; mostly dilated RV with preserved systolic function), class 3 (13%, mostly dilated RV with impaired systolic function), and class 4 (21%; mostly high cardiac output, with hyperdynamic LV function). The four subphenotypes differed in their characteristics and outcomes, with 90-day mortality rates of 19%, 40%, 78%, and 59% in classes 1-4, respectively ( p < 0.0001). Following multivariable logistic regression analysis, class 3 had the highest odds ratio (OR) for mortality (OR, 6.9; 95% CI, 4.0-11.8) compared with other RVD definitions. Different three-variable models had high diagnostic accuracy in identifying each of these latent subphenotypes.
LCA of TTE parameters identified four cardiovascular subphenotypes in ARDS that more closely aligned with circulatory failure mechanisms and mortality than current RVD definitions.
利用聚类方法对经胸超声心动图（TTE）检查结果和血流动力学参数进行分析，以对急性呼吸窘迫综合征（ARDS）患者的循环衰竭亚表型进行特征描述，并阐明潜在机制，并与当前右心功能障碍（RVD）定义相比，描述其与死亡率的相关性。
回顾性、单中心队列研究。
英国伯明翰大学医院 ICU。
2016 年 4 月至 2021 年 12 月期间，ARDS 发病后 7 天内接受 TTE 检查的 ICU 患者。
无。
对 801 例患者的 TTE/血流动力学参数进行潜在类别分析（LCA），患者年龄 62 岁（四分位距，50-72 岁），男性占 63%，90 天死亡率为 40%。确定了四个心血管亚表型：表型 1（43%；左、右心室功能多为正常）、表型 2（24%；多为扩张性右心室，收缩功能正常）、表型 3（13%；多为扩张性右心室，收缩功能受损）和表型 4（21%；多为高心输出量，左心室功能呈高动力状态）。这四个亚表型的特征和结局不同，表型 1-4 的 90 天死亡率分别为 19%、40%、78%和 59%（p<0.0001）。多变量逻辑回归分析后，表型 3 的死亡率比值比（OR）最高（OR，6.9；95%CI，4.0-11.8），与其他 RVD 定义相比。不同的三变量模型对识别这些潜在亚表型具有较高的诊断准确性。
TTE 参数的 LCA 确定了 ARDS 中的四个心血管亚表型，与当前的 RVD 定义相比，这些亚表型更能与循环衰竭机制和死亡率相关。
