Publication: Biological subphenotypes of acute respiratory distress syndrome show prognostic enrichment in mechanically ventilated patients without acute respiratory distress syndrome
Issued Date
2021-06-15
Resource Type
ISSN
15354970
1073449X
1073449X
Other identifier(s)
2-s2.0-85107042993
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Mahidol University
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SCOPUS
Bibliographic Citation
American Journal of Respiratory and Critical Care Medicine. Vol.203, No.12 (2021), 1503-1511
Suggested Citation
Nanon F.L. Heijnen, Laura A. Hagens, Marry R. Smit, Olaf L. Cremer, David S.Y. Ong, Tom Van Der Poll, Lonneke A. Van Vught, Brendon P. Scicluna, Ronny M. Schnabel, Iwan C.C. Van Der Horst, Marcus J. Schultz, Dennis C.J.J. Bergmans, Lieuwe D.J. Bos, Friso M. De Beer, Lieuwe D. Bos, Gerie J. Glas, Janneke Horn, Arie J. Hoogendijk, Roosmarijn T. Van Hooijdonk, Mischa A. Huson, Tom Van Der Poll, Laura R. Schouten, Marcus J. Schultz, Marleen Straat, Luuk Wieske, Maryse A. Wievel, Esther Witteveen, Marc J. Bonten, Jos F. Frencken, Kirsten Van De Groep, Peter M. Klein Klouwenberg, Maria E. Koster-Brouwer, Meri R. Varkila, Diana M. Verboom Biological subphenotypes of acute respiratory distress syndrome show prognostic enrichment in mechanically ventilated patients without acute respiratory distress syndrome. American Journal of Respiratory and Critical Care Medicine. Vol.203, No.12 (2021), 1503-1511. doi:10.1164/rccm.202006-2522OC Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/78121
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Title
Biological subphenotypes of acute respiratory distress syndrome show prognostic enrichment in mechanically ventilated patients without acute respiratory distress syndrome
Author(s)
Nanon F.L. Heijnen
Laura A. Hagens
Marry R. Smit
Olaf L. Cremer
David S.Y. Ong
Tom Van Der Poll
Lonneke A. Van Vught
Brendon P. Scicluna
Ronny M. Schnabel
Iwan C.C. Van Der Horst
Marcus J. Schultz
Dennis C.J.J. Bergmans
Lieuwe D.J. Bos
Friso M. De Beer
Lieuwe D. Bos
Gerie J. Glas
Janneke Horn
Arie J. Hoogendijk
Roosmarijn T. Van Hooijdonk
Mischa A. Huson
Tom Van Der Poll
Laura R. Schouten
Marcus J. Schultz
Marleen Straat
Luuk Wieske
Maryse A. Wievel
Esther Witteveen
Marc J. Bonten
Jos F. Frencken
Kirsten Van De Groep
Peter M. Klein Klouwenberg
Maria E. Koster-Brouwer
Meri R. Varkila
Diana M. Verboom
Laura A. Hagens
Marry R. Smit
Olaf L. Cremer
David S.Y. Ong
Tom Van Der Poll
Lonneke A. Van Vught
Brendon P. Scicluna
Ronny M. Schnabel
Iwan C.C. Van Der Horst
Marcus J. Schultz
Dennis C.J.J. Bergmans
Lieuwe D.J. Bos
Friso M. De Beer
Lieuwe D. Bos
Gerie J. Glas
Janneke Horn
Arie J. Hoogendijk
Roosmarijn T. Van Hooijdonk
Mischa A. Huson
Tom Van Der Poll
Laura R. Schouten
Marcus J. Schultz
Marleen Straat
Luuk Wieske
Maryse A. Wievel
Esther Witteveen
Marc J. Bonten
Jos F. Frencken
Kirsten Van De Groep
Peter M. Klein Klouwenberg
Maria E. Koster-Brouwer
Meri R. Varkila
Diana M. Verboom
Other Contributor(s)
University Medical Center Utrecht
Mahidol University
Nuffield Department of Medicine
Maastricht Universitair Medisch Centrum+
Amsterdam UMC - University of Amsterdam
Franciscus Gasthuis & Vlietland
Center of Infection and Immunity
Laboratory of Experimental Intensive Care and Anesthesiology
Division of Infectious Diseases
Mahidol University
Nuffield Department of Medicine
Maastricht Universitair Medisch Centrum+
Amsterdam UMC - University of Amsterdam
Franciscus Gasthuis & Vlietland
Center of Infection and Immunity
Laboratory of Experimental Intensive Care and Anesthesiology
Division of Infectious Diseases
Abstract
Rationale: Recent studies showed that biological subphenotypes in acute respiratory distress syndrome (ARDS) provide prognostic enrichment and show potential for predictive enrichment. Objectives: To determine whether these subphenotypes and their prognostic and potential for predictive enrichment could be extended to other patients in the ICU, irrespective of fulfilling the definition of ARDS. Methods: This is a secondary analysis of a prospective observational study of adult patients admitted to the ICU. We tested the prognostic enrichment of both cluster-derived and latentclass analysis (LCA)-derived biological ARDS subphenotypes by evaluating the association with clinical outcome (ICU-day, 30-day mortality, and ventilator-free days) using logistic regression and Cox regression analysis. We performed a principal component analysis to compare blood leukocyte gene expression profiles between subphenotypes and the presence of ARDS. Measurements and Main Results: We included 2,499 mechanically ventilated patients (674 with and 1,825 without ARDS). The cluster-derived "reactive"subphenotype was, independently of ARDS, significantly associated with a higher probability of ICU mortality, higher 30-day mortality, and a lower probability of successful extubation while alive compared with the "uninflamed"subphenotype. The blood leukocyte gene expression profiles of individual subphenotypes were similar for patients with and without ARDS. LCA-derived subphenotypes also showed similar profiles. Conclusions: The prognostic and potential for predictive enrichment of biological ARDS subphenotypes may be extended to mechanically ventilated critically ill patients without ARDS. Using the concept of biological subphenotypes for splitting cohorts of critically ill patients could add to improving future precision-based trial strategies and lead to identifying treatable traits for all critically ill patients.