Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.
Center for Anesthesia Research Excellence (CARE), Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Intensive Care Med. 2023 Dec;49(12):1499-1507. doi: 10.1007/s00134-023-07244-z. Epub 2023 Oct 31.
Latent class analysis (LCA) has identified hyper- and non-hyper-inflammatory subphenotypes in patients with acute respiratory distress syndrome (ARDS). It is unknown how early inflammatory subphenotypes can be identified in patients at risk of ARDS. We aimed to test for inflammatory subphenotypes upon presentation to the emergency department.
LIPS-A was a trial of aspirin to prevent ARDS in at-risk patients presenting to the emergency department. In this secondary analysis, we performed LCA using clinical, blood test, and biomarker variables.
Among 376 (96.4%) patients from the LIPS-A trial, two classes were identified upon presentation to the emergency department (day 0): 72 (19.1%) patients demonstrated characteristics of a hyper-inflammatory and 304 (80.9%) of a non-hyper-inflammatory subphenotype. 15.3% of patients in the hyper- and 8.2% in the non-hyper-inflammatory class developed ARDS (p = 0.07). Patients in the hyper-inflammatory class had fewer ventilator-free days (median [interquartile range, IQR] 28[23-28] versus 28[27-28]; p = 0.010), longer intensive care unit (3[2-6] versus 0[0-3] days; p < 0.001) and hospital (9[6-18] versus 5[3-9] days; p < 0.001) length of stay, and higher 1-year mortality (34.7% versus 20%; p = 0.008). Subphenotypes were identified on day 1 and 4 in a subgroup with available data (n = 244). 77.9% of patients remained in their baseline class throughout day 4. Patients with a hyper-inflammatory subphenotype throughout the study period (n = 22) were at higher risk of ARDS (36.4% versus 10.4%; p = 0.003).
Hyper- and non-hyper-inflammatory subphenotypes may precede ARDS development, remain identifiable over time, and can be identified upon presentation to the emergency department. A hyper-inflammatory subphenotype predicts worse outcomes.
潜类别分析（LCA）已经确定了急性呼吸窘迫综合征（ARDS）患者的超炎症和非超炎症亚表型。目前尚不清楚如何在有 ARDS 风险的患者中早期识别炎症亚表型。我们旨在测试急诊就诊时的炎症亚表型。
LIPS-A 是一项阿司匹林预防高危患者 ARDS 的试验。在这项二次分析中，我们使用临床、血液测试和生物标志物变量进行 LCA。
在 LIPS-A 试验的 376 名（96.4%）患者中，在急诊就诊时确定了两个亚组（第 0 天）：72 名（19.1%）患者表现出超炎症特征，304 名（80.9%）患者表现出非超炎症亚表型。超炎症组和非超炎症组中分别有 15.3%和 8.2%的患者发生 ARDS（p=0.07）。超炎症组患者的无呼吸机天数较少（中位数[四分位距，IQR]28[23-28]与 28[27-28]；p=0.010），住重症监护病房的时间更长（3[2-6]与 0[0-3]天；p<0.001）和住院时间更长（9[6-18]与 5[3-9]天；p<0.001），1 年死亡率更高（34.7%与 20%；p=0.008）。在有可用数据的亚组（n=244）中，在第 1 天和第 4 天确定了亚表型。77.9%的患者在第 4 天仍处于基线亚组。整个研究期间存在超炎症亚表型的患者（n=22）发生 ARDS 的风险更高（36.4%与 10.4%；p=0.003）。
超炎症和非超炎症亚表型可能先于 ARDS 发生，可以随时间识别，并可在急诊就诊时识别。超炎症亚表型预示着更差的预后。
