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Subphenotypes of SARS-CoV-2-Associated ARDS Overlap Each Other: A Retrospective Analysis

Background  Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus-associated pneumonia and acute respiratory distress syndrome (ARDS) were often associated with hyperinflammation and elevation of several serum inflammatory markers but usually less than what is observed in non-coronaviru...

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Autores principales: Nair, Parvathy R., Girish, Kavitha, Mini, Gouri, Khan, Tazeen, Haritha, Damarla, Sanyal, Koninica, Bhattacharjee, Sulagna, Baidya, Dalim K., Ray, Bikash R., Anand, Rahul K., Datta, Sudip K., Soneja, Manish, Subramaniam, Rajeshwari, Maitra, Souvik
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Thieme Medical and Scientific Publishers Pvt. Ltd. 2023
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10539064/
https://www.ncbi.nlm.nih.gov/pubmed/37780871
http://dx.doi.org/10.1055/s-0043-1768952
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author Nair, Parvathy R.
Girish, Kavitha
Mini, Gouri
Khan, Tazeen
Haritha, Damarla
Sanyal, Koninica
Bhattacharjee, Sulagna
Baidya, Dalim K.
Ray, Bikash R.
Anand, Rahul K.
Datta, Sudip K.
Soneja, Manish
Subramaniam, Rajeshwari
Maitra, Souvik
author_facet Nair, Parvathy R.
Girish, Kavitha
Mini, Gouri
Khan, Tazeen
Haritha, Damarla
Sanyal, Koninica
Bhattacharjee, Sulagna
Baidya, Dalim K.
Ray, Bikash R.
Anand, Rahul K.
Datta, Sudip K.
Soneja, Manish
Subramaniam, Rajeshwari
Maitra, Souvik
author_sort Nair, Parvathy R.
collection PubMed
description Background  Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus-associated pneumonia and acute respiratory distress syndrome (ARDS) were often associated with hyperinflammation and elevation of several serum inflammatory markers but usually less than what is observed in non-coronavirus disease (COVID) ARDS. Elevated inflammatory markers such as C-reactive protein, interleukin (IL)-6, etc., are associated with severe infection. This study identified subphenotypes of COVID-19 ARDS patients by latent profile analysis in a cohort of Indian patients. Methods  Data of n  = 233 adult Indian patients with laboratory-confirmed SARS-CoV-2 infection admitted to a tertiary care teaching hospital were analyzed in this retrospective study. Only patients with acute respiratory failure (defined by partial pressure of oxygen/fraction of inspired oxygen ratio < 200 mm Hg) and chest X-ray showing bilateral infiltrates were included. Results  The patients' mean (standard deviation) age was 53.3 (14.9) years, and 62% were male. A two subphenotypic model was formulated based on the lowest Bayesian information criterion. Neutrophil-to-lymphocyte ratio and serum IL-6 were latent variables in that model (entropy 0.91). The second phenotype (hyperinflammatory) had lower platelet count ( p  = 0.02), higher serum creatinine ( p  = 0.004), higher C-reactive protein ( p  = 0.001), higher ferritin ( p  < 0.001), and serum lactate dehydrogenase ( p  = 0.009). Age-adjusted hospital mortality ( p  = 0.007), duration of hospital stay ( p  < 0.001), and duration of intensive care unit stay ( p  < 0.001) were significantly higher in the second subphenotype. Conclusion  Two distinct but overlapping subphenotypes were identified in SARS-CoV-2-associated respiratory failure. Hyperinflammatory subphenotype was associated with significantly poor short-term outcomes.
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spelling pubmed-105390642023-09-29 Subphenotypes of SARS-CoV-2-Associated ARDS Overlap Each Other: A Retrospective Analysis Nair, Parvathy R. Girish, Kavitha Mini, Gouri Khan, Tazeen Haritha, Damarla Sanyal, Koninica Bhattacharjee, Sulagna Baidya, Dalim K. Ray, Bikash R. Anand, Rahul K. Datta, Sudip K. Soneja, Manish Subramaniam, Rajeshwari Maitra, Souvik J Lab Physicians Background  Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus-associated pneumonia and acute respiratory distress syndrome (ARDS) were often associated with hyperinflammation and elevation of several serum inflammatory markers but usually less than what is observed in non-coronavirus disease (COVID) ARDS. Elevated inflammatory markers such as C-reactive protein, interleukin (IL)-6, etc., are associated with severe infection. This study identified subphenotypes of COVID-19 ARDS patients by latent profile analysis in a cohort of Indian patients. Methods  Data of n  = 233 adult Indian patients with laboratory-confirmed SARS-CoV-2 infection admitted to a tertiary care teaching hospital were analyzed in this retrospective study. Only patients with acute respiratory failure (defined by partial pressure of oxygen/fraction of inspired oxygen ratio < 200 mm Hg) and chest X-ray showing bilateral infiltrates were included. Results  The patients' mean (standard deviation) age was 53.3 (14.9) years, and 62% were male. A two subphenotypic model was formulated based on the lowest Bayesian information criterion. Neutrophil-to-lymphocyte ratio and serum IL-6 were latent variables in that model (entropy 0.91). The second phenotype (hyperinflammatory) had lower platelet count ( p  = 0.02), higher serum creatinine ( p  = 0.004), higher C-reactive protein ( p  = 0.001), higher ferritin ( p  < 0.001), and serum lactate dehydrogenase ( p  = 0.009). Age-adjusted hospital mortality ( p  = 0.007), duration of hospital stay ( p  < 0.001), and duration of intensive care unit stay ( p  < 0.001) were significantly higher in the second subphenotype. Conclusion  Two distinct but overlapping subphenotypes were identified in SARS-CoV-2-associated respiratory failure. Hyperinflammatory subphenotype was associated with significantly poor short-term outcomes. Thieme Medical and Scientific Publishers Pvt. Ltd. 2023-07-03 /pmc/articles/PMC10539064/ /pubmed/37780871 http://dx.doi.org/10.1055/s-0043-1768952 Text en The Indian Association of Laboratory Physicians. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.
spellingShingle Nair, Parvathy R.
Girish, Kavitha
Mini, Gouri
Khan, Tazeen
Haritha, Damarla
Sanyal, Koninica
Bhattacharjee, Sulagna
Baidya, Dalim K.
Ray, Bikash R.
Anand, Rahul K.
Datta, Sudip K.
Soneja, Manish
Subramaniam, Rajeshwari
Maitra, Souvik
Subphenotypes of SARS-CoV-2-Associated ARDS Overlap Each Other: A Retrospective Analysis
title Subphenotypes of SARS-CoV-2-Associated ARDS Overlap Each Other: A Retrospective Analysis
title_full Subphenotypes of SARS-CoV-2-Associated ARDS Overlap Each Other: A Retrospective Analysis
title_fullStr Subphenotypes of SARS-CoV-2-Associated ARDS Overlap Each Other: A Retrospective Analysis
title_full_unstemmed Subphenotypes of SARS-CoV-2-Associated ARDS Overlap Each Other: A Retrospective Analysis
title_short Subphenotypes of SARS-CoV-2-Associated ARDS Overlap Each Other: A Retrospective Analysis
title_sort subphenotypes of sars-cov-2-associated ards overlap each other: a retrospective analysis
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10539064/
https://www.ncbi.nlm.nih.gov/pubmed/37780871
http://dx.doi.org/10.1055/s-0043-1768952
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