1. Latent Class Analysis Reveals COVID-19–related Acute Respiratory Distress Syndrome Subgroups with Differential Responses to Corticosteroids
- Author
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Jeremy R. Beitler, Shelief Y Robbins-Juarez, Kevin L. Delucchi, Matthew J. Cummings, Kristin M. Burkart, Darryl Abrams, Daniel Brodie, Pratik Sinha, Natalie H Yip, Cara Agerstrand, Manoj V Maddali, June He, Carolyn S. Calfee, Alex K. Lyashchenko, Alison Thompson, John Fountain, Mahesh V. Madhavan, Tejus Satish, David Furfaro, Michael Murn, Max R. O'Donnell, Amanda Rosen, Matthew A Adan, Matthew R. Baldwin, and Aakriti Gupta
- Subjects
Male ,Pulmonary and Respiratory Medicine ,ARDS ,medicine.medical_specialty ,phenotyping ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Respiratory System ,Population ,Columbia university ,Critical Care and Intensive Care Medicine ,Medical and Health Sciences ,Positive-Pressure Respiration ,Cohort Studies ,chemistry.chemical_compound ,Rare Diseases ,Adrenal Cortex Hormones ,Internal medicine ,latent class analysis ,medicine ,Humans ,education ,Acute Respiratory Distress Syndrome ,Lung ,Retrospective Studies ,Aged ,Respiratory Distress Syndrome ,Creatinine ,education.field_of_study ,biology ,SARS-CoV-2 ,business.industry ,COVID-19 ,Original Articles ,Middle Aged ,medicine.disease ,Troponin ,Latent class model ,COVID-19 Drug Treatment ,Infectious Diseases ,Emerging Infectious Diseases ,Good Health and Well Being ,chemistry ,Latent Class Analysis ,biology.protein ,Female ,business ,COVID-19/Critical Care - Abstract
Rationale Two distinct subphenotypes have been identified in acute respiratory distress syndrome (ARDS), but the presence of subgroups in ARDS associated with COVID-19 is unknown. The objective of this study was to identify clinically relevant, novel subgroups in COVID-19-related ARDS, and compare them to previously described ARDS subphenotypes. Methods Eligible participants were adults with COVID-19 and ARDS at Columbia University Irving Medical Center. Latent class analysis (LCA) was used to identify subgroups with baseline clinical, respiratory, and laboratory data serving as partitioning variables. A previously-developed machine learning model was used to classify patients as the hypoinflammatory and hyperinflammatory subphenotypes. Baseline characteristics and clinical outcomes were compared between subgroups. Heterogeneity of treatment effect (HTE) for corticosteroid-use in subgroups was tested. Measurements and Main Results From 3/2-4/30/2020, 483 patients with COVID-19-related ARDS met study criteria. A two-class LCA model best fit the population (p=0.0075). Class 2 (23%) had higher pro-inflammatory markers, troponin, creatinine and lactate, lower bicarbonate and lower blood pressure than Class 1 (77%). 90-day mortality was higher in Class 2 versus Class 1 (75% vs 48%; p
- Published
- 2021
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