Identification of novel sub-phenotypes of severe ARDS requiring ECMO using latent class analysis.
Computed tomography
In-hospital mortality
Latent class analysis
Severe acute respiratory distress syndrome
Veno-venous extracorporeal membrane oxygenation
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
24 Oct 2024
24 Oct 2024
Historique:
received:
12
05
2024
accepted:
21
10
2024
medline:
25
10
2024
pubmed:
25
10
2024
entrez:
25
10
2024
Statut:
epublish
Résumé
Sub-phenotyping of acute respiratory distress syndrome (ARDS) could be useful for evaluating the severity of ARDS or predicting its responsiveness to given therapeutic strategies, but no studies have yet investigated the heterogeneity of patients with severe ARDS requiring veno-venous extracorporeal membrane oxygenation (V-V ECMO). We conducted this retrospective multicenter observational study in adult patients with severe ARDS treated by V-V ECMO. We performed latent class analysis (LCA) for identifying sub-phenotypes of severe ARDS based on the radiological and clinical findings at the start of ECMO support. Multivariate Cox regression analysis was conducted to investigate the differences in mortality and association between the PEEP setting of ≥ 10 cmH We identified three sub-phenotypes from analysis of the data of a total of 544 patients with severe ARDS treated by V-V ECMO, as follows: Dry type (n = 185; 34%); Wet type (n = 169; 31%); and Fibrotic type (n = 190; 35%). The 90-days in-hospital mortality risk was higher in the patients with the Fibrotic type than in those with the Dry type (adjusted hazard ratio [95% confidence interval] 1.75 [1.10-2.79], p = 0.019) or the Wet type (1.50 [1.02-2.23], p = 0.042). The PEEP setting of ≥ 10 cmH The three sub-phenotypes showed different mortality rates and different relationships between higher PEEP settings in the early phase of V-V ECMO and patient outcomes. Our data suggest that we may need to change our management approach to patients with severe ARDS during V-V ECMO according to their clinical sub-phenotype.
Sections du résumé
BACKGROUND
BACKGROUND
Sub-phenotyping of acute respiratory distress syndrome (ARDS) could be useful for evaluating the severity of ARDS or predicting its responsiveness to given therapeutic strategies, but no studies have yet investigated the heterogeneity of patients with severe ARDS requiring veno-venous extracorporeal membrane oxygenation (V-V ECMO).
METHODS
METHODS
We conducted this retrospective multicenter observational study in adult patients with severe ARDS treated by V-V ECMO. We performed latent class analysis (LCA) for identifying sub-phenotypes of severe ARDS based on the radiological and clinical findings at the start of ECMO support. Multivariate Cox regression analysis was conducted to investigate the differences in mortality and association between the PEEP setting of ≥ 10 cmH
RESULTS
RESULTS
We identified three sub-phenotypes from analysis of the data of a total of 544 patients with severe ARDS treated by V-V ECMO, as follows: Dry type (n = 185; 34%); Wet type (n = 169; 31%); and Fibrotic type (n = 190; 35%). The 90-days in-hospital mortality risk was higher in the patients with the Fibrotic type than in those with the Dry type (adjusted hazard ratio [95% confidence interval] 1.75 [1.10-2.79], p = 0.019) or the Wet type (1.50 [1.02-2.23], p = 0.042). The PEEP setting of ≥ 10 cmH
CONCLUSIONS
CONCLUSIONS
The three sub-phenotypes showed different mortality rates and different relationships between higher PEEP settings in the early phase of V-V ECMO and patient outcomes. Our data suggest that we may need to change our management approach to patients with severe ARDS during V-V ECMO according to their clinical sub-phenotype.
Identifiants
pubmed: 39449081
doi: 10.1186/s13054-024-05143-3
pii: 10.1186/s13054-024-05143-3
doi:
Types de publication
Journal Article
Observational Study
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
343Subventions
Organisme : JSPS KAKENHI
ID : JP 22K09120
Organisme : Japanese Association for Acute Medicine, and Japan Agency for Medical Research and Development
ID : JP23fk0108654
Investigateurs
Jun Hamaguchi
(J)
Kazuki Matsumura
(K)
Kenji Fujizuka
(K)
Yoshihiro Hagiwara
(Y)
Ryuichi Nakayama
(R)
Naofumi Bunya
(N)
Junichi Maruyama
(J)
Takayuki Ogura
(T)
Mitsunobu Nakamura
(M)
Keiki Shimizu
(K)
Mamoru Masuda
(M)
Informations de copyright
© 2024. The Author(s).
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