Profiles and outcomes in patients with COVID-19 admitted to wards of a French oncohematological hospital: A clustering approach

Abstract

Objectives Although some prognostic factors for COVID-19 were consistently identified across the studies, differences were found for other factors that could be due to the characteristics of the study populations and the variables incorporated into the statistical model. We aimed to a priori identify specific patient profiles and then assess their association with the outcomes in COVID-19 patients with respiratory symptoms admitted specifically to hospital wards. Methods We conducted a retrospective single-center study from February 2020 to April 2020. A non-supervised cluster analysis was first used to detect patient profiles based on characteristics at admission of 220 consecutive patients admitted to our institution. Then, we assessed the prognostic value using Cox regression analyses to predict survival. Results Three clusters were identified, with 47 patients in cluster 1, 87 in cluster 2, and 86 in cluster 3; the presentation of the patients differed among the clusters. Cluster 1 mostly included sexagenarian patients with active malignancies who were admitted early after the onset of COVID-19. Cluster 2 included the oldest patients, who were generally overweight and had hypertension and renal insufficiency, while cluster 3 included the youngest patients, who had gastrointestinal symptoms and delayed admission. Sixty-day survival rates were 74.3%, 50.6% and 96.5% in clusters 1, 2, and 3, respectively. This was confirmed by the multivariable Cox analyses that showed the prognostic value of these patterns. Conclusion The cluster approach seems appropriate and pragmatic for the early identification of patient profiles that could help physicians segregate patients according to their prognosis.

Clinical-epidemiologic variation in patients treated in the first and second wave of COVID-19 in Lambayeque, Peru: A cluster analysis

“…Nevertheless, this cluster had the second highest number of patients with renal disease and cancer, surpassed only by cluster 4. This is similar to what was found in a French study, in which only 4% of patients in cluster 1 had acute renal failure (Bondeelle et al, 2021;Cholankeril et al, 2020;Pan et al, 2020;Tian et al, 2020;Zhang et al, 2020).…”

“…Cluster 2 presented a high frequency of patients with risk factors for COVID-19 including cardiovascular disease, diabetes, obesity, and pulmonary disease, and was only surpassed by the "severe" cluster 3. These results partially coincide with a cluster study conducted in France, which showed a higher proportion of systemic, respiratory, and gastrointestinal symptoms in cluster 3, characterized by the highest survival rate in oncohematology patients (Bondeelle et al, 2021). Our findings also partially coincide with those of study performed in China, in which cough was predominant in group B, classified as "intermediate-severe."…”

“…With respect to age, this cluster was characterized by the highest proportion of children and adolescents between 5 and 17 years of age, as well as young people and adults. These results are similar to those described in a cluster study of COVID-19 patients by a French group in which their cluster 3 was made up by young patients with gastrointestinal symptoms and had the highest survival rate (96.5%) (Bondeelle et al, 2021).…”

“…The cluster 3 was dominated by the largest number of individuals with comorbidities, similar to what was described by Bondeelle et al who identified a higher proportion of comorbidities in patients grouped in cluster 2, characterized by the lowest survival rate (50.6%) (Bondeelle et al, 2021). Additionally, our findings coincide with those of a study carried out in the United States following a cluster analysis, which found more than 50% of patients with the lowest proportion of SARS-CoV-2 positivity without comorbidities, concluding that presenting comorbidities represents a risk factor for severe .…”

“…and this sign differed among clusters, making it important to address as a serious prognostic factor (Bondeelle et al, 2021). In a study performed in China, the second-highest proportion of dyspnea was found in patients in cluster A with greater severity (35.2%) (31).…”