Subphenotypes in patients with acute respiratory distress syndrome treated with high-flow oxygen
Blot, Pierre-Louis (Hôpital Lariboisière)
Chousterman, Benjamin G. (IHôpital Lariboisière)
Santafè, Manel (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Cartailler, Jerôme (Hôpital Lariboisière)
Pacheco, Andrés (Hospital Universitari Vall d'Hebron)
Magret, Mònica (Hospital Universitari Joan XXIII de Tarragona)
Masclans, Joan R. (Universitat Pompeu Fabra)
Artigas, Antoni (Insituto de Salud Carlos III)
Roca, Oriol (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
García-de-Acilu, Marina (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Universitat Autònoma de Barcelona

Fecha:	2023
Resumen:	Background: Acute respiratory distress syndrome (ARDS) subphenotypes differ in outcomes and treatment responses. Subphenotypes in high-flow nasal oxygen (HFNO)-treated ARDS patients have not been investigated. Objectives: To identify biological subphenotypes in HFNO-treated ARDS patients. Methods: Secondary analysis of a prospective multicenter observational study including ARDS patients supported with HFNO. Plasma inflammation markers (interleukin [IL]-6, IL-8, and IL-33 and soluble suppression of tumorigenicity-2 [sST2]) and lung epithelial (receptor for advanced glycation end products [RAGE] and surfactant protein D [SP-D]) and endothelial (angiopoietin-2 [Ang-2]) injury were measured. These biomarkers and bicarbonate were used in K-means cluster analysis to identify subphenotypes. Logistic regression was performed on biomarker combinations to predict clustering. We chose the model with the best AUROC and the lowest number of variables. This model was used to describe the HAIS (High-flow ARDS Inflammatory Subphenotype) score. Results: Among 41 HFNO patients, two subphenotypes were identified. Hyperinflammatory subphenotype (n = 17) showed higher biomarker levels than hypoinflammatory (n = 24). Despite similar baseline characteristics, the hyperinflammatory subphenotype had higher 60-day mortality (47 vs 8. 3% p = 0. 014) and longer ICU length of stay (22. 0 days [18. 0-30. 0] vs 39. 5 [25. 5-60. 0], p = 0. 034). The HAIS score, based on IL-8 and sST2, accurately distinguished subphenotypes (AUROC 0. 96 [95%CI: 0. 90-1. 00]). A HAIS score ≥ 7. 45 was predictor of hyperinflammatory subphenotype. Conclusion: ARDS patients treated with HFNO exhibit two biological subphenotypes that have similar clinical characteristics, but hyperinflammatory patients have worse outcomes. The HAIS score may identify patients with hyperinflammatory subphenotype and might be used for enrichment strategies in future clinical trials.
Ayudas:	Instituto de Salud Carlos III PI14/01420
Derechos:	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.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Acute respiratory distress syndrome ; Biomarkers ; High-flow nasal cannula ; High-flow nasal oxygen ; Inflammation ; Non-invasive ventilation ; Subphenotypes
Publicado en:	Critical care, Vol. 27 Núm. 1 (december 2023) , p. 419, ISSN 1466-609X

DOI: 10.1186/s13054-023-04687-0
PMID: 37915062

8 p, 1.4 MB

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