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[Intensive Care Med发表论文]:ARDS高危患者的验证亚表型
2024年02月10日 时讯速递, 进展交流 [Intensive Care Med发表论文]:ARDS高危患者的验证亚表型已关闭评论

Inflammatory subphenotypes in patients at risk of ARDS: evidence from the LIPS-A trial

Redaelli, S., von Wedel, D., Fosset, M. et al

Intensive Care Med 49, 1499–1507 (2023). https://doi.org/10.1007/s00134-023-07244-z

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusion

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.

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