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Title: Association between pre-operative biological phenotypes and postoperative pulmonary complications: An unbiased cluster analysis
Authors: Ary Serpa Neto
Lieuwe D. Bos
Pedro P.Z.A. Campos
Sabrine N.T. Hemmes
Thomas Bluth
Carolyn S. Calfee
Marion Ferner
Andreas Güldner
Markus W. Hollmann
Inmaculada India
Thomas Kiss
Rita Laufenberg-Feldmann
Juraj Sprung
Demet Sulemanji
Carmen Unzueta
Marcos F. Vidal Melo
Toby N. Weingarten
Anita M. Tuip-de Boer
Paolo Pelosi
Marcelo Gama de Abreu
Marcus J. Schultz
University of Amsterdam
Keywords: Medicine
Issue Date: 1-Sep-2018
Citation: European journal of anaesthesiology. Vol.35, No.9 (2018), 702-709
Abstract: BACKGROUND: Biological phenotypes have been identified within several heterogeneous pulmonary diseases, with potential therapeutic consequences. OBJECTIVE: To assess whether distinct biological phenotypes exist within surgical patients, and whether development of postoperative pulmonary complications (PPCs) and subsequent dependence of intra-operative positive end-expiratory pressure (PEEP) differ between such phenotypes. SETTING: Operating rooms of six hospitals in Europe and USA. DESIGN: Secondary analysis of the 'PROtective Ventilation with HIgh or LOw PEEP' trial. PATIENTS: Adult patients scheduled for abdominal surgery who are at risk of PPCs. INTERVENTIONS: Measurement of pre-operative concentrations of seven plasma biomarkers associated with inflammation and lung injury. MAIN OUTCOME MEASURES: We applied unbiased cluster analysis to identify biological phenotypes. We then compared the proportion of patients developing PPCs within each phenotype, and associations between intra-operative PEEP levels and development of PPCs among phenotypes. RESULTS: In total, 242 patients were included. Unbiased cluster analysis clustered the patients within two biological phenotypes. Patients with phenotype 1 had lower plasma concentrations of TNF-α (3.8 [2.4 to 5.9] vs. 10.2 [8.0 to 12.1] pg ml; P < 0.001), IL-6 (2.3 [1.5 to 4.0] vs. 4.0 [2.9 to 6.5] pg ml; P < 0.001) and IL-8 (4.7 [3.1 to 8.1] vs. 8.1 [6.0 to 13.9] pg ml; P < 0.001). Phenotype 2 patients had the highest incidence of PPC (69.8 vs. 34.2% in type 1; P < 0.001). There was no interaction between phenotype and PEEP level for the development of PPCs (43.2% in high PEEP vs. 25.6% in low PEEP in phenotype 1, and 73.6% in high PEEP and 65.7% in low PEEP in phenotype 2; P for interaction = 0.503). CONCLUSION: Patients at risk of PPCs and undergoing open abdominal surgery can be clustered based on pre-operative plasma biomarker concentrations. The two identified phenotypes have different incidences of PPCs. Biologic phenotyping could be useful in future randomised controlled trials of intra-operative ventilation. TRIAL REGISTRATION: The PROtective Ventilation with HIgh or LOw PEEP trial, including the substudy from which data were used for the present analysis, was registered at (NCT01441791).
ISSN: 13652346
Appears in Collections:Scopus 2018

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