ARDS subphenotypes: searching for Rorschach among the roentgenograms?

Morris, Andrew Conway; Köhler, Katharina; Shankar-Hari, Manu

doi:10.1136/thoraxjnl-2021-217428

Cited by 3 publications

(3 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Numerous prior studies have demonstrated that bacterial coinfections are the exception rather than the norm for patients hospitalized with COVID-19. [39][40][41][42] However, these patients are at high risk for nosocomial bacterial infections, consistent with our observation that many more patients with SARS-CoV-2-associated sepsis had positive cultures across their entire hospitalizations. 17,43 Our findings may help increase awareness of the underrecognized contribution of viral pathogens to sepsis and to improve nuance in our approach to sepsis diagnosis and treatment.…”

Section: Discussionsupporting

confidence: 88%

Use of Electronic Clinical Data to Track Incidence and Mortality for SARS-CoV-2–Associated Sepsis

Shappell,

Klompas,

Chan

et al. 2023

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceEfforts to quantify the burden of SARS-CoV-2–associated sepsis have been limited by inconsistent definitions and underrecognition of viral sepsis.ObjectiveTo describe the incidence and outcomes of SARS-CoV-2–associated sepsis vs presumed bacterial sepsis using objective electronic clinical criteria.Design, Setting, and ParticipantsThis retrospective cohort study included adults hospitalized at 5 Massachusetts hospitals between March 2020 and November 2022.ExposuresSARS-CoV-2–associated sepsis was defined as a positive SARS-CoV-2 polymerase chain reaction test and concurrent organ dysfunction (ie, oxygen support above simple nasal cannula, vasopressors, elevated lactate level, rise in creatine or bilirubin level, and/or decline in platelets). Presumed bacterial sepsis was defined by modified US Centers for Disease Control and Prevention adult sepsis event criteria (ie, blood culture order, sustained treatment with antibiotics, and organ dysfunction using identical thresholds as for SARS-CoV-2–associated sepsis).Main Outcomes and MeasuresTrends in the quarterly incidence (ie, proportion of hospitalizations) and in-hospital mortality for SARS-CoV-2–associated and presumed bacterial sepsis were assessed using negative binomial and logistic regression models.ResultsThis study included 431 017 hospital encounters from 261 595 individuals (mean [SD] age 57.9 [19.8] years, 241 131 (55.9%) females, 286 397 [66.5%] from academic hospital site). Of these encounters, 23 276 (5.4%) were from SARS-CoV-2, 6558 (1.5%) had SARS-CoV-2–associated sepsis, and 30 604 patients (7.1%) had presumed bacterial sepsis without SARS-CoV-2 infection. Crude in-hospital mortality for SARS-CoV-2–associated sepsis declined from 490 of 1469 (33.4%) in the first quarter to 67 of 450 (14.9%) in the last (adjusted odds ratio [aOR], 0.88 [95% CI, 0.85-0.90] per quarter). Crude mortality for presumed bacterial sepsis was 4451 of 30 604 patients (14.5%) and stable across quarters (aOR, 1.00 [95% CI, 0.99-1.01]). Medical record reviews of 200 SARS-CoV-2–positive hospitalizations confirmed electronic health record (EHR)–based SARS-CoV-2–associated sepsis criteria performed well relative to sepsis-3 criteria (90.6% [95% CI, 80.7%-96.5%] sensitivity; 91.2% [95% CI, 85.1%-95.4%] specificity).Conclusions and RelevanceIn this retrospective cohort study of hospitalized adults, SARS-CoV-2 accounted for approximately 1 in 6 cases of sepsis during the first 33 months of the COVID-19 pandemic. In-hospital mortality rates for SARS-CoV-2–associated sepsis were high but declined over time and ultimately were similar to presumed bacterial sepsis. These findings highlight the high burden of SARS-CoV-2–associated sepsis and demonstrate the utility of EHR-based algorithms to conduct surveillance for viral and bacterial sepsis.

show abstract

Section: Discussionsupporting

confidence: 88%

Use of Electronic Clinical Data to Track Incidence and Mortality for SARS-CoV-2–Associated Sepsis

Shappell,

Klompas,

Chan

et al. 2023

JAMA Netw Open

View full text Add to dashboard Cite

show abstract

“…Biomarker differences between seropositive and seronegative patients in our study represent altered interferon responses [ 33 ], and compromised humoral immunity [ 12 , 13 , 30 ] in critically ill COVID-19 patients. Prognostic associations with many of these biomarkers have been reported previously in acute respiratory distress syndrome [ 45 ].…”

Section: Discussionmentioning

confidence: 89%

Coronavirus disease 2019 subphenotypes and differential treatment response to convalescent plasma in critically ill adults: secondary analyses of a randomized clinical trial

et al. 2022

Self Cite

View full text Add to dashboard Cite

Purpose Benefit from convalescent plasma therapy for coronavirus disease 2019 (COVID-19) has been inconsistent in randomized clinical trials (RCTs) involving critically ill patients. As COVID-19 patients are immunologically heterogeneous, we hypothesized that immunologically similar COVID-19 subphenotypes may differ in their treatment responses to convalescent plasma and explain inconsistent findings between RCTs . Methods We tested this hypothesis in a substudy involving 1239 patients, by measuring 26 biomarkers (cytokines, chemokines, endothelial biomarkers) within the randomized, embedded, multifactorial, adaptive platform trial for community-acquired pneumonia (REMAP-CAP) that assigned 2097 critically ill COVID-19 patients to either high-titer convalescent plasma or usual care. Primary outcome was organ support free days at 21 days (OSFD-21) . Results Unsupervised analyses identified three subphenotypes/endotypes. In contrast to the more homogeneous subphenotype-2 ( N = 128 patients, 10.3%; with elevated type i and type ii effector immune responses) and subphenotype-3 ( N = 241, 19.5%; with exaggerated inflammation), the subphenotype-1 had variable biomarker patterns ( N = 870 patients, 70.2%). Subphenotypes-2, and -3 had worse outcomes, and subphenotype-1 had better outcomes with convalescent plasma therapy compared with usual care (median (IQR). OSFD-21 in convalescent plasma vs usual care was 0 (− 1, 21) vs 10 (− 1, to 21) in subphenotype-2; 1.5 (− 1, 21) vs 12 (− 1, to 21) in suphenotype-3, and 0 (− 1, 21) vs 0 (− 1, to 21) in subphenotype-1 (test for between-subphenotype differences in treatment effects p = 0.008). Conclusions We reported three COVID-19 subphenotypes, among critically ill adults, with differential treatment effects to ABO-compatible convalescent plasma therapy. Differences in subphenotype prevalence between RCT populations probably explain inconsistent results with COVID-19 immunotherapies. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-022-06869-w.

show abstract

“…Manu Shankar-Hari (Edinburgh, UK) described a molecular signature with a cytokine pattern connected to each ARDS phenotype [ 22 – 24 ]. Targeting inflammation positively impacts mortality.…”

Section: Beyond Covid-19: Translating Covid-19 Treatment Successes To...mentioning

confidence: 99%

ERS International Congress 2022: highlights from the Respiratory Intensive Care Assembly

et al. 2023

View full text Add to dashboard Cite

Early Career Members of Assembly 2 (Respiratory Intensive Care) attended the 2022 European Respiratory Society Annual Congress in Barcelona. The conference covered acute and chronic respiratory failure. Sessions of interest to our Assembly members and to those interested in respiratory critical care included the state-of-the-art session on respiratory critical care, the journal session (ERS/Lancet) on acute respiratory distress syndrome (ARDS) phenotyping into precision medicine, specificity of COVID-19 ARDS and its post critical care. A symposium on treatment of acute respiratory failure in patients with chronic obstructive pulmonary disease and innovations in mechanical ventilation either in intensive care unit or at home were also reported. These sessions are summarized in this article.

show abstract

ARDS subphenotypes: searching for Rorschach among the roentgenograms?

Cited by 3 publications

References 9 publications

Use of Electronic Clinical Data to Track Incidence and Mortality for SARS-CoV-2–Associated Sepsis

Use of Electronic Clinical Data to Track Incidence and Mortality for SARS-CoV-2–Associated Sepsis

Coronavirus disease 2019 subphenotypes and differential treatment response to convalescent plasma in critically ill adults: secondary analyses of a randomized clinical trial

ERS International Congress 2022: highlights from the Respiratory Intensive Care Assembly

Contact Info

Product

Resources

About