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Clinical sepsis phenotypes in critically ill COVID-19 patients.
Bruse, Niklas; Kooistra, Emma J; Jansen, Aron; van Amstel, Rombout B E; de Keizer, Nicolette F; Kennedy, Jason N; Seymour, Christopher; van Vught, Lonneke A; Pickkers, Peter; Kox, Matthijs.
  • Bruse N; Department of Intensive Care Medicine, Radboud University Medical Center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.
  • Kooistra EJ; Department of Intensive Care Medicine, Radboud University Medical Center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.
  • Jansen A; Department of Intensive Care Medicine, Radboud University Medical Center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.
  • van Amstel RBE; Department of Intensive Care Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands.
  • de Keizer NF; Department of Medical Informatics, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.
  • Kennedy JN; Quality of Care & Methodology, Amsterdam Public Health, Amsterdam, The Netherlands.
  • Seymour C; National Intensive Care Evaluation (NICE) Foundation, Amsterdam, The Netherlands.
  • van Vught LA; Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
  • Pickkers P; Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
  • Kox M; Department of Intensive Care Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands.
Crit Care ; 26(1): 244, 2022 08 09.
Article in English | MEDLINE | ID: covidwho-1978786
ABSTRACT

BACKGROUND:

A greater understanding of disease heterogeneity may facilitate precision medicine for coronavirus disease 2019 (COVID-19). Previous work identified four distinct clinical phenotypes associated with outcome and treatment responses in non-COVID-19 sepsis patients, but it is unknown if and how these phenotypes are recapitulated in COVID-19 sepsis patients.

METHODS:

We applied the four non-COVID-19 sepsis phenotypes to a total of 52,274 critically ill patients, comprising two cohorts of COVID-19 sepsis patients (admitted before and after the introduction of dexamethasone as standard treatment) and three non-COVID-19 sepsis cohorts (non-COVID-19 viral pneumonia sepsis, bacterial pneumonia sepsis, and bacterial sepsis of non-pulmonary origin). Differences in proportions of phenotypes and their associated mortality were determined across these cohorts.

RESULTS:

Phenotype distribution was highly similar between COVID-19 and non-COVID-19 viral pneumonia sepsis cohorts, whereas the proportion of patients with the δ-phenotype was greater in both bacterial sepsis cohorts compared to the viral sepsis cohorts. The introduction of dexamethasone treatment was associated with an increased proportion of patients with the δ-phenotype (6% vs. 11% in the pre- and post-dexamethasone COVID-19 cohorts, respectively, p < 0.001). Across the cohorts, the α-phenotype was associated with the most favorable outcome, while the δ-phenotype was associated with the highest mortality. Survival of the δ-phenotype was markedly higher following the introduction of dexamethasone (60% vs 41%, p < 0.001), whereas no relevant differences in survival were observed for the other phenotypes among COVID-19 patients.

CONCLUSIONS:

Classification of critically ill COVID-19 patients into clinical phenotypes may aid prognostication, prediction of treatment efficacy, and facilitation of personalized medicine.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia / Communicable Diseases / Sepsis / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Limits: Humans Language: English Journal: Crit Care Year: 2022 Document Type: Article Affiliation country: S13054-022-04118-6

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia / Communicable Diseases / Sepsis / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Limits: Humans Language: English Journal: Crit Care Year: 2022 Document Type: Article Affiliation country: S13054-022-04118-6