Identification of distinct clinical phenotypes of acute respiratory distress syndrome with differential responses to treatment

作者：Xiaowei Liu, Yusheng Jiang, X. Jia, Xiaohui Ma, Ci Han, Nana Guo, Ya-hui Peng, Haitao Liu, Yingnan Ju, Xiangfeng Luo, Xueting Li, Y. Bu, Jin Zhang, Yan-Song Liu, Yan Gao, Mingyan Zhao, Hong-Liang Wang, Ligang Luo, Kai-Jiang Yu, Changsong Wang · 发表于：Critical Care · 年份：2021 · DOI：10.1186/s13054-021-03734-y · 被引用次数：40 · 研究领域：Medicine

Background Acute respiratory distress syndrome (ARDS) is a heterogeneous syndrome, and the identification of homogeneous subgroups and phenotypes is the first step toward precision critical care. We aimed to explore whether ARDS phenotypes can be identified using clinical data, are reproducible and are associated with clinical outcomes and treatment response. Methods This study is based on a retrospective analysis of data from the telehealth intensive care unit (eICU) collaborative research database and three ARDS randomized controlled trials (RCTs) (ALVEOLI, FACTT and SAILS trials). We derived phenotypes in the eICU by cluster analysis based on clinical data and compared the clinical characteristics and outcomes of each phenotype. The reproducibility of the derived phenotypes was tested using the data from three RCTs, and treatment effects were evaluated. Results Three clinical phenotypes were identified in the training cohort of 3875 ARDS patients. Of the three phenotypes identified, phenotype I ( n  = 1565; 40%) was associated with fewer laboratory abnormalities, less organ dysfunction and the lowest in-hospital mortality rate (8%). Phenotype II ( n  = 1232; 32%) was correlated with more inflammation and shock and had a higher mortality rate (18%). Phenotype III ( n  = 1078; 28%) was strongly correlated with renal dysfunction and acidosis and had the highest mortality rate (22%). These results were validated using the data from the validation cohort ( n  = 3670) and three ...