Clinical sepsis phenotypes in critically ill COVID-19 patients

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...

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Published in:Critical care (London, England) Vol. 26; no. 1; pp. 1 - 6
Main Authors: 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
Format: Journal Article
Language:English
Published: London BioMed Central 09.08.2022
BioMed Central Ltd
Springer Nature B.V
BMC
Subjects:
Blood
Brief Report
Care and treatment
Coronaviruses
COVID-19
Creatinine
Critical care
Critical Care Medicine
Critically ill
Dexamethasone
Dosage and administration
Emergency Medicine
Genotype & phenotype
Intensive
Intensive care
Medicine
Medicine & Public Health
Mortality
Patients
Personalized medicine
Phenotypes
Pneumonia
Precision medicine
Prevention
Risk factors
Sepsis
Severe acute respiratory syndrome coronavirus 2
Steroids
United States
COVID-19
Sepsis
Phenotypes
Dexamethasone
Personalized medicine
ISSN:1364-8535, 1466-609X, 1364-8535, 1366-609X, 1466-609X
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Summary: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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ISSN:1364-8535
1466-609X
1364-8535
1366-609X
1466-609X
DOI:10.1186/s13054-022-04118-6