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Community-acquired pneumonia subgroups and differential response to corticosteroids: a secondary analysis of controlled studies
BACKGROUND: Latent class analysis (LCA) has identified subgroups with meaningful treatment implications in acute respiratory distress syndrome. We performed a secondary analysis of three studies to assess whether LCA can identify clinically distinct subgroups in community-acquired pneumonia (CAP) an...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
European Respiratory Society
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8752939/ https://www.ncbi.nlm.nih.gov/pubmed/35036417 http://dx.doi.org/10.1183/23120541.00489-2021 |
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author | Wittermans, Esther van der Zee, Philip A. Qi, Hongchao van de Garde, Ewoudt M.W. Blum, Claudine A. Christ-Crain, Mirjam Gommers, Diederik Grutters, Jan C. Voorn, G. Paul Bos, Willem Jan W. Endeman, Henrik |
author_facet | Wittermans, Esther van der Zee, Philip A. Qi, Hongchao van de Garde, Ewoudt M.W. Blum, Claudine A. Christ-Crain, Mirjam Gommers, Diederik Grutters, Jan C. Voorn, G. Paul Bos, Willem Jan W. Endeman, Henrik |
author_sort | Wittermans, Esther |
collection | PubMed |
description | BACKGROUND: Latent class analysis (LCA) has identified subgroups with meaningful treatment implications in acute respiratory distress syndrome. We performed a secondary analysis of three studies to assess whether LCA can identify clinically distinct subgroups in community-acquired pneumonia (CAP) and whether the treatment effect of adjunctive corticosteroids differs between subgroups. METHODS: LCA was performed on baseline clinical and biomarker data from the Ovidius trial (n=304) and the Steroids in Pneumonia (STEP) trial (n=727), both randomised controlled trials investigating adjunctive corticosteroid treatment in CAP, and the observational TripleP cohort (n=201). Analyses were conducted independently in two cohorts (Ovidius–TripleP combined and the STEP trial). In both cohorts, differences in clinical outcomes and response to adjunctive corticosteroid treatment were examined between subgroups identified through LCA. RESULTS: A two-class model fitted both cohorts best. Class 2 patients had more signs of systemic inflammation compared to class 1. In both cohorts, length of stay was longer and in-hospital mortality rate was higher in class 2. In the Ovidius trial, corticosteroids reduced the median length of stay in class 2 (6.5 versus 9.5 days) but not in class 1 (p-value for interaction=0.02). In the STEP trial, there was no significant interaction for length of stay. We found no significant interaction between class assignment and adjunctive corticosteroid treatment for secondary outcomes. CONCLUSIONS: In two independent cohorts, LCA identified two classes of CAP patients with different clinical characteristics and outcomes. Given the different response to adjunctive corticosteroids in the Ovidius trial, LCA might provide a useful basis to improve patient selection for future trials. |
format | Online Article Text |
id | pubmed-8752939 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | European Respiratory Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-87529392022-01-13 Community-acquired pneumonia subgroups and differential response to corticosteroids: a secondary analysis of controlled studies Wittermans, Esther van der Zee, Philip A. Qi, Hongchao van de Garde, Ewoudt M.W. Blum, Claudine A. Christ-Crain, Mirjam Gommers, Diederik Grutters, Jan C. Voorn, G. Paul Bos, Willem Jan W. Endeman, Henrik ERJ Open Res Original Research Articles BACKGROUND: Latent class analysis (LCA) has identified subgroups with meaningful treatment implications in acute respiratory distress syndrome. We performed a secondary analysis of three studies to assess whether LCA can identify clinically distinct subgroups in community-acquired pneumonia (CAP) and whether the treatment effect of adjunctive corticosteroids differs between subgroups. METHODS: LCA was performed on baseline clinical and biomarker data from the Ovidius trial (n=304) and the Steroids in Pneumonia (STEP) trial (n=727), both randomised controlled trials investigating adjunctive corticosteroid treatment in CAP, and the observational TripleP cohort (n=201). Analyses were conducted independently in two cohorts (Ovidius–TripleP combined and the STEP trial). In both cohorts, differences in clinical outcomes and response to adjunctive corticosteroid treatment were examined between subgroups identified through LCA. RESULTS: A two-class model fitted both cohorts best. Class 2 patients had more signs of systemic inflammation compared to class 1. In both cohorts, length of stay was longer and in-hospital mortality rate was higher in class 2. In the Ovidius trial, corticosteroids reduced the median length of stay in class 2 (6.5 versus 9.5 days) but not in class 1 (p-value for interaction=0.02). In the STEP trial, there was no significant interaction for length of stay. We found no significant interaction between class assignment and adjunctive corticosteroid treatment for secondary outcomes. CONCLUSIONS: In two independent cohorts, LCA identified two classes of CAP patients with different clinical characteristics and outcomes. Given the different response to adjunctive corticosteroids in the Ovidius trial, LCA might provide a useful basis to improve patient selection for future trials. European Respiratory Society 2022-01-10 /pmc/articles/PMC8752939/ /pubmed/35036417 http://dx.doi.org/10.1183/23120541.00489-2021 Text en Copyright ©The authors 2022 https://creativecommons.org/licenses/by-nc/4.0/This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. For commercial reproduction rights and permissions contact permissions@ersnet.org (mailto:permissions@ersnet.org) |
spellingShingle | Original Research Articles Wittermans, Esther van der Zee, Philip A. Qi, Hongchao van de Garde, Ewoudt M.W. Blum, Claudine A. Christ-Crain, Mirjam Gommers, Diederik Grutters, Jan C. Voorn, G. Paul Bos, Willem Jan W. Endeman, Henrik Community-acquired pneumonia subgroups and differential response to corticosteroids: a secondary analysis of controlled studies |
title | Community-acquired pneumonia subgroups and differential response to corticosteroids: a secondary analysis of controlled studies |
title_full | Community-acquired pneumonia subgroups and differential response to corticosteroids: a secondary analysis of controlled studies |
title_fullStr | Community-acquired pneumonia subgroups and differential response to corticosteroids: a secondary analysis of controlled studies |
title_full_unstemmed | Community-acquired pneumonia subgroups and differential response to corticosteroids: a secondary analysis of controlled studies |
title_short | Community-acquired pneumonia subgroups and differential response to corticosteroids: a secondary analysis of controlled studies |
title_sort | community-acquired pneumonia subgroups and differential response to corticosteroids: a secondary analysis of controlled studies |
topic | Original Research Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8752939/ https://www.ncbi.nlm.nih.gov/pubmed/35036417 http://dx.doi.org/10.1183/23120541.00489-2021 |
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