Dong Minhui, Chen Song, Lin Shilong, Han Fei, Zhong Ming
Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
Ann Transl Med. 2023 Mar 15;11(5):220. doi: 10.21037/atm-22-2541. Epub 2023 Feb 16.
Since the outbreak of the 2019 novel coronavirus disease (COVID-19), acute respiratory distress syndrome (ARDS) and sepsis resulting from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have surged in intensive care units around the world. The heterogeneity of ARDS and sepsis has long been observed, and multiple subphenotypes and endotypes correlated with different outcomes and treatment response have been identified in the search for treatable traits. Despite their similarity to typical ARDS and sepsis, COVID-19-associated ARDS and sepsis harbor distinct features, raising the question as to whether they could be considered as subphenotypes or endotypes of the historical syndromes and, accordingly, benefit from specific therapeutic strategies. This review aimed to summarize and discuss the current knowledge of COVID-19-associated critical illness and the intrinsic subphenotypes or endotypes.
Literature on the pathogenesis of COVID-19 and the subphenotyping of COVID-19-associated critical illness was derived from the PubMed database and reviewed.
Accumulating evidence, varying from clinical observation to basic research, has contributed to revealing the fundamental pathophysiological features of severe COVID-19 and has advanced our knowledge of the disease. COVID-19-associated ARDS and sepsis exhibit some distinctive features compared to the classic syndromes, including remarkable vascular abnormality and coagulopathy, and distinct respiratory mechanics and immune response. Some conventional subphenotypes derived from classic ARDS and sepsis have been validated in COVID-19, while novel subphenotypes and endotypes have also been identified in patients with this disease, who experience variable clinical outcomes and treatment responses.
Subphenotyping of COVID-19-associated ARDS and sepsis can provide new insights into the development and management of these illnesses.
自2019年新型冠状病毒病（COVID-19）爆发以来，由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染导致的急性呼吸窘迫综合征（ARDS）和脓毒症在全球重症监护病房中激增。长期以来，人们一直观察到ARDS和脓毒症具有异质性，并且在寻找可治疗特征的过程中，已经确定了与不同结局和治疗反应相关的多种亚表型和内型。尽管COVID-19相关的ARDS和脓毒症与典型的ARDS和脓毒症相似，但它们具有明显的特征，这就引发了一个问题，即它们是否可以被视为历史综合征的亚表型或内型，以及是否因此能从特定的治疗策略中获益。本综述旨在总结和讨论关于COVID-19相关危重症及其内在亚表型或内型的现有知识。
从PubMed数据库中获取并综述了关于COVID-19发病机制以及COVID-19相关危重症亚分型的文献。
从临床观察到基础研究，越来越多的证据有助于揭示重症COVID-19的基本病理生理特征，并增进了我们对该疾病的了解。与经典综合征相比，COVID-19相关的ARDS和脓毒症表现出一些独特的特征，包括显著的血管异常和凝血病，以及独特的呼吸力学和免疫反应。一些源自经典ARDS和脓毒症的传统亚表型已在COVID-19中得到验证，同时在患有这种疾病的患者中也发现了新的亚表型和内型，这些患者具有不同的临床结局和治疗反应。
对COVID-19相关ARDS和脓毒症进行亚分型可为这些疾病的发展和管理提供新的见解。
