Clustering COVID-19 ARDS patients through the first days of ICU admission. An analysis of the CIBERESUCICOVID Cohort

(Hospital Universitario de Getafe (Madrid))
Menendez, Rosario (Hospital Universitari i Politècnic La Fe (València))
Amaya-Villar, Rosario (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Añón, José Manuel (Hospital Universitario La Paz (Madrid))
Balan-Mariño, Ana (Hospital Universitario San Agustín (Avilés))
Barberà, Carme (Hospital Santa Maria (Lleida))
Barberán, Jose (Hospital Universitario HM Montepríncipe (Madrid))
Blandino-Ortiz, Aaron (Universidad de Alcalá)
Boado Varela, Maria Victoria (Hospital Universitario de Cruces (Barakaldo, País Basc))
Bustamante-Munguira, Elena (Hospital Clínico Universitario (Valladolid))
Caballero, Jesús

(Hospital Universitari Arnau de Vilanova)
Carbajales, Cristina

(Hospital Álvaro Cunqueiro (Vigo))
Carbonell, Nieves

(Hospital Clínic Universitari (València))
Catalán-González, Mercedes (Hospital Universitario 12 de Octubre (Madrid))
Franco, Nieves (Hospital Universitario de Móstoles (Madrid))
Galbán, Cristóbal (Complejo Hospitalario Universitario de Santiago de Compostela)
Gumucio-Sanguino, Víctor (Hospital Universitari de Bellvitge)
de la Torre, Maria Del Carmen (Hospital de Mataró. Consorci Sanitari del Maresme)
Estella, Ángel

(Universidad de Cádiz (Andalusia))
Gallego, Elena (Hospital Universitario San Pedro de Alcántara (Cáceres))
García-Garmendia, José Luis (Hospital San Juan de Dios del Aljarafe (Sevilla, Andalusia))
Garnacho-Montero, José

(Hospital Universitario Virgen Macarena (Sevilla, Andalusia))
Gómez, José M. (Hospital General Universitario Gregorio Marañón)
Huerta, Arturo

(Clínica Sagrada Familia (Barcelona, Catalunya))
Jorge-García, Ruth Noemí (Hospital Nuestra Señora de Gracia (Saragossa))
Loza-Vázquez, Ana (Hospital Universitario Virgen de Valme (Sevilla, Andalusia))
Marin-Corral, Judith

(Institut Hospital del Mar d'Investigacions Mèdiques)
Martínez de la Gándara, Amalia (Hospital Universitario Infanta Leonor)
Martin-Delgado, Maria Cruz (Hospital Universitario Torrejón-Universidad Francisco de Vitoria (Madrid))
Martínez-Varela, Ignacio Y. (Hospital Universitario Lucus Augusti (Lugo))
Messa, Juan L. (Complejo Asistencial Universitario de Palencia (Castella i LLeó))
Muñiz-Albaiceta, Guillermo (Universidad de Oviedo)
Nieto, Maite (Hospital General de Segovia (Castella i LLeó))
Novo, Mariana Andrea (Hospital Universitari Son Espases (Palma de Mallorca, Balears))
Peñasco, Yhivian (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))
Pozo-Laderas, Juan Carlos (Hospital Universitario Reina Sofía (Còrdova, Espanya))
Pérez-García, Felipe

(Instituto de Salud Carlos III)
Ricart, Pilar

(Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Roche-Campo, Ferran (Institut d'Investigació Sanitària Pere Virgili (IISPV)(Tortosa, Baix Ebre))
Rodríguez, Alejandro (Hospital Universitari Joan XXIII de Tarragona)
Sagredo, Victor (Hospital Universitario de Salamanca (Castella i LLeó))
Sánchez-Miralles, Angel (Hospital Universitario San Juan de Alicante)
Sancho-Chinesta, Susana (Hospital Universitari i Politècnic La Fe (València))
Socias, Lorenzo (Hospital Universitari Son Llàtzer (Palma de Mallorca, Balears))
Sole-Violan, Jordi

(Hospital Universitario de Gran Canaria Dr. Negrín)
Suarez-Sipmann, Fernando

(Hospital Universitario La Princesa (Madrid))
Tamayo-Lomas, Luis (Hospital Universitario Río Hortega de Valladolid (Castella i Lleó))
Trenado Álvarez, José

(Hospital Universitari MútuaTerrassa (Terrassa, Catalunya))
Úbeda, Alejandro (Hospital Punta de Europa (Cadis, Andalusia))
Valdivia, Luis Jorge (Hospital Universitario de León)
Vidal, Pablo (Complexo Hospitalario Universitario de Ourense - CHUO)
Bermejo, Jesus (Instituto de Investigación Biomédica de Salamanca (IBSAL)(Castella i Lleó))
Gonzalez, Jesica (Hospital Universitari Arnau de Vilanova)
Barbé, Ferran

(Hospital Universitari Arnau de Vilanova)
Calfee, Carolyn S. (University of California (Estats Units d'Amèrica))
Artigas Raventós, Antoni

(Instituto de Salud Carlos III)
Torres, Antoni

(Hospital Clínic i Provincial de Barcelona)
Universitat Autònoma de Barcelona

Data:	2024
Resum:	Background: Acute respiratory distress syndrome (ARDS) can be classified into sub-phenotypes according to different inflammatory/clinical status. Prognostic enrichment was achieved by grouping patients into hypoinflammatory or hyperinflammatory sub-phenotypes, even though the time of analysis may change the classification according to treatment response or disease evolution. We aimed to evaluate when patients can be clustered in more than 1 group, and how they may change the clustering of patients using data of baseline or day 3, and the prognosis of patients according to their evolution by changing or not the cluster. Methods: Multicenter, observational prospective, and retrospective study of patients admitted due to ARDS related to COVID-19 infection in Spain. Patients were grouped according to a clustering mixed-type data algorithm (k-prototypes) using continuous and categorical readily available variables at baseline and day 3. Results: Of 6205 patients, 3743 (60%) were included in the study. According to silhouette analysis, patients were grouped in two clusters. At baseline, 1402 (37%) patients were included in cluster 1 and 2341(63%) in cluster 2. On day 3, 1557(42%) patients were included in cluster 1 and 2086 (57%) in cluster 2. The patients included in cluster 2 were older and more frequently hypertensive and had a higher prevalence of shock, organ dysfunction, inflammatory biomarkers, and worst respiratory indexes at both time points. The 90-day mortality was higher in cluster 2 at both clustering processes (43. 8% [n = 1025] versus 27. 3% [n = 383] at baseline, and 49% [n = 1023] versus 20. 6% [n = 321] on day 3). Four hundred and fifty-eight (33%) patients clustered in the first group were clustered in the second group on day 3. In contrast, 638 (27%) patients clustered in the second group were clustered in the first group on day 3. Conclusions: During the first days, patients can be clustered into two groups and the process of clustering patients may change as they continue to evolve. This means that despite a vast majority of patients remaining in the same cluster, a minority reaching 33% of patients analyzed may be re-categorized into different clusters based on their progress. Such changes can significantly impact their prognosis.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	ARDS ; Clustering ; Mortality ; Precision medicine
Publicat a:	Critical care, Vol. 28 Núm. 1 (december 2024) , p. 91, ISSN 1466-609X

DOI: 10.1186/s13054-024-04876-5
PMID: 38515193

12 p, 1.3 MB

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