Sivasubramanium V.\u00a0Bhavani,\u00a0Chad\u00a0Robichaux,\u00a0Philip A.\u00a0Verhoef, et al<\/h3>\n\n\n\nChest 2024; 165: 529-539<\/h3>\n\n\n\nhttps:\/\/doi.org\/10.1016\/j.chest.2023.09.020<\/a><\/h3>\n\n\n\nBackground<\/h3>\n\n\n\n
Trajectories of bedside vital signs have been used to identify sepsis subphenotypes with distinct outcomes and treatment responses. The objective of this study was to validate the vitals trajectory model in a multicenter cohort of patients hospitalized with COVID-19 and to evaluate the clinical characteristics and outcomes of the resulting subphenotypes.<\/p>\n\n\n\n
Research Question<\/h3>\n\n\n\n
Can the trajectory of routine bedside vital signs identify COVID-19 subphenotypes with distinct clinical characteristics and outcomes?<\/p>\n\n\n\n
Study Design and Methods<\/h3>\n\n\n\n
The study included adult patients admitted with COVID-19 to four academic hospitals in the Emory Healthcare system between March 1, 2020, and May 31, 2022. Using a validated group-based trajectory model, we classified patients into previously defined vital sign trajectories using oral temperature, heart rate, respiratory rate, and systolic and diastolic BP measured in the first 8 h of hospitalization. Clinical characteristics, biomarkers, and outcomes were compared between subphenotypes. Heterogeneity of treatment effect to tocilizumab<\/a> was evaluated.<\/p>\n\n\n\nResults<\/h3>\n\n\n\n
The 7,065 patients with hospitalized COVID-19 were classified into four subphenotypes: group A (n\u00a0= 1,429, 20%)\u2014high temperature, heart rate, respiratory rate, and hypotensive; group B (1,454, 21%)\u2014high temperature, heart rate, respiratory rate, and hypertensive; group C (2,996, 42%)\u2014low temperature, heart rate, respiratory rate, and normotensive; and group D (1,186, 17%)\u2014low temperature, heart rate, respiratory rate, and hypotensive. Groups A and D had higher ORs of\u00a0mechanical ventilation<\/a>, vasopressors, and 30-day inpatient mortality (P<\/em>\u00a0< .001). On comparing patients receiving tocilizumab (n\u00a0= 55) with those who met criteria for tocilizumab but were admitted before its use (n\u00a0= 461), there was significant heterogeneity of treatment effect across subphenotypes in the association of tocilizumab with 30-day mortality (P<\/em>\u00a0= .001).<\/p>\n\n\n\n![\"\"\/](\"https:\/\/ars.els-cdn.com\/content\/image\/1-s2.0-S0012369223055423-gr1_lrg.jpg\")
<\/figure>\n\n\n\n![\"\"\/](\"https:\/\/ars.els-cdn.com\/content\/image\/1-s2.0-S0012369223055423-gr2_lrg.jpg\")
<\/figure>\n\n\n\n![\"\"\/](\"https:\/\/ars.els-cdn.com\/content\/image\/1-s2.0-S0012369223055423-gr3_lrg.jpg\")
<\/figure>\n\n\n\n![\"\"\/](\"https:\/\/ars.els-cdn.com\/content\/image\/1-s2.0-S0012369223055423-gr4_lrg.jpg\")
<\/figure>\n\n\n\nInterpretation<\/h3>\n\n\n\n
By using bedside vital signs available in even low-resource settings, we found novel subphenotypes associated with distinct manifestations of COVID-19, which could lead to preemptive and targeted treatments<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"Chest Infections: Original Research Using Trajectories […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25681"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=25681"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25681\/revisions"}],"predecessor-version":[{"id":25682,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25681\/revisions\/25682"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=25681"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=25681"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=25681"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
https:\/\/doi.org\/10.1016\/j.chest.2023.09.020<\/a><\/h3>\n\n\n\nBackground<\/h3>\n\n\n\n
Trajectories of bedside vital signs have been used to identify sepsis subphenotypes with distinct outcomes and treatment responses. The objective of this study was to validate the vitals trajectory model in a multicenter cohort of patients hospitalized with COVID-19 and to evaluate the clinical characteristics and outcomes of the resulting subphenotypes.<\/p>\n\n\n\n
Research Question<\/h3>\n\n\n\n
Can the trajectory of routine bedside vital signs identify COVID-19 subphenotypes with distinct clinical characteristics and outcomes?<\/p>\n\n\n\n
Study Design and Methods<\/h3>\n\n\n\n
The study included adult patients admitted with COVID-19 to four academic hospitals in the Emory Healthcare system between March 1, 2020, and May 31, 2022. Using a validated group-based trajectory model, we classified patients into previously defined vital sign trajectories using oral temperature, heart rate, respiratory rate, and systolic and diastolic BP measured in the first 8 h of hospitalization. Clinical characteristics, biomarkers, and outcomes were compared between subphenotypes. Heterogeneity of treatment effect to tocilizumab<\/a> was evaluated.<\/p>\n\n\n\nResults<\/h3>\n\n\n\n
The 7,065 patients with hospitalized COVID-19 were classified into four subphenotypes: group A (n\u00a0= 1,429, 20%)\u2014high temperature, heart rate, respiratory rate, and hypotensive; group B (1,454, 21%)\u2014high temperature, heart rate, respiratory rate, and hypertensive; group C (2,996, 42%)\u2014low temperature, heart rate, respiratory rate, and normotensive; and group D (1,186, 17%)\u2014low temperature, heart rate, respiratory rate, and hypotensive. Groups A and D had higher ORs of\u00a0mechanical ventilation<\/a>, vasopressors, and 30-day inpatient mortality (P<\/em>\u00a0< .001). On comparing patients receiving tocilizumab (n\u00a0= 55) with those who met criteria for tocilizumab but were admitted before its use (n\u00a0= 461), there was significant heterogeneity of treatment effect across subphenotypes in the association of tocilizumab with 30-day mortality (P<\/em>\u00a0= .001).<\/p>\n\n\n\n<\/figure>\n\n\n\n<\/figure>\n\n\n\n<\/figure>\n\n\n\n<\/figure>\n\n\n\nInterpretation<\/h3>\n\n\n\n
By using bedside vital signs available in even low-resource settings, we found novel subphenotypes associated with distinct manifestations of COVID-19, which could lead to preemptive and targeted treatments<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"Chest Infections: Original Research Using Trajectories […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25681"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=25681"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25681\/revisions"}],"predecessor-version":[{"id":25682,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25681\/revisions\/25682"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=25681"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=25681"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=25681"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Results<\/h3>\n\n\n\n
The 7,065 patients with hospitalized COVID-19 were classified into four subphenotypes: group A (n\u00a0= 1,429, 20%)\u2014high temperature, heart rate, respiratory rate, and hypotensive; group B (1,454, 21%)\u2014high temperature, heart rate, respiratory rate, and hypertensive; group C (2,996, 42%)\u2014low temperature, heart rate, respiratory rate, and normotensive; and group D (1,186, 17%)\u2014low temperature, heart rate, respiratory rate, and hypotensive. Groups A and D had higher ORs of\u00a0mechanical ventilation<\/a>, vasopressors, and 30-day inpatient mortality (P<\/em>\u00a0< .001). On comparing patients receiving tocilizumab (n\u00a0= 55) with those who met criteria for tocilizumab but were admitted before its use (n\u00a0= 461), there was significant heterogeneity of treatment effect across subphenotypes in the association of tocilizumab with 30-day mortality (P<\/em>\u00a0= .001).<\/p>\n\n\n\n By using bedside vital signs available in even low-resource settings, we found novel subphenotypes associated with distinct manifestations of COVID-19, which could lead to preemptive and targeted treatments<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":" Chest Infections: Original Research Using Trajectories […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25681"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=25681"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25681\/revisions"}],"predecessor-version":[{"id":25682,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25681\/revisions\/25682"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=25681"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=25681"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=25681"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}<\/figure>\n\n\n\n<\/figure>\n\n\n\n<\/figure>\n\n\n\n<\/figure>\n\n\n\nInterpretation<\/h3>\n\n\n\n