1. Identifying organ dysfunction trajectory-based subphenotypes in critically ill patients with COVID-19
- Author
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Sergio Alvarez-Mulett, Chang Su, Katherine Hoffman, Fei Wang, Edward J. Schenck, Fernando J. Martinez, Zhenxing Xu, Parag Goyal, Luis Gomez-Escobar, Jerry Lee, Monika M. Safford, Thomas R. Campion, David R. Price, Lisa K. Torres, and John Harrington
- Subjects
Male ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Organ Dysfunction Scores ,Critical Illness ,Multiple Organ Failure ,Science ,Severity of Illness Index ,Article ,Internal medicine ,Severity of illness ,medicine ,Humans ,Aged ,Hemophagocytic lymphohistiocytosis ,Multidisciplinary ,SARS-CoV-2 ,business.industry ,Respiration ,Organ dysfunction ,COVID-19 ,Middle Aged ,Prognosis ,medicine.disease ,Pathophysiology ,Respiratory failure ,Viral infection ,Medicine ,Female ,SOFA score ,medicine.symptom ,business - Abstract
COVID-19-associated respiratory failure offers the unprecedented opportunity to evaluate the differential host response to a uniform pathogenic insult. Understanding whether there are distinct subphenotypes of severe COVID-19 may offer insight into its pathophysiology. Sequential Organ Failure Assessment (SOFA) score is an objective and comprehensive measurement that measures dysfunction severity of six organ systems, i.e., cardiovascular, central nervous system, coagulation, liver, renal, and respiration. Our aim was to identify and characterize distinct subphenotypes of COVID-19 critical illness defined by the post-intubation trajectory of SOFA score. Intubated COVID-19 patients at two hospitals in New York city were leveraged as development and validation cohorts. Patients were grouped into mild, intermediate, and severe strata by their baseline post-intubation SOFA. Hierarchical agglomerative clustering was performed within each stratum to detect subphenotypes based on similarities amongst SOFA score trajectories evaluated by Dynamic Time Warping. Distinct worsening and recovering subphenotypes were identified within each stratum, which had distinct 7-day post-intubation SOFA progression trends. Patients in the worsening suphenotypes had a higher mortality than those in the recovering subphenotypes within each stratum (mild stratum, 29.7% vs. 10.3%, p = 0.033; intermediate stratum, 29.3% vs. 8.0%, p = 0.002; severe stratum, 53.7% vs. 22.2%, p
- Published
- 2021