Publication: Association between pre-operative biological phenotypes and postoperative pulmonary complications: An unbiased cluster analysis
Issued Date
2018-09-01
Resource Type
ISSN
13652346
Other identifier(s)
2-s2.0-85061031737
Rights
Mahidol University
Rights Holder(s)
SCOPUS
Bibliographic Citation
European journal of anaesthesiology. Vol.35, No.9 (2018), 702-709
Suggested Citation
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 Association between pre-operative biological phenotypes and postoperative pulmonary complications: An unbiased cluster analysis. European journal of anaesthesiology. Vol.35, No.9 (2018), 702-709. doi:10.1097/EJA.0000000000000846 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/46409
Research Projects
Organizational Units
Authors
Journal Issue
Thesis
Title
Association between pre-operative biological phenotypes and postoperative pulmonary complications: An unbiased cluster analysis
Author(s)
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
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
Other Contributor(s)
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 ClinicalTrials.gov (NCT01441791).