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CC BY-NC-ND 4.0 · J Lab Physicians 2023; 15(04): 558-561
DOI: 10.1055/s-0043-1768952
Original Article

Subphenotypes of SARS-CoV-2-Associated ARDS Overlap Each Other: A Retrospective Analysis

Parvathy R. Nair
1   Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
,
Kavitha Girish
1   Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
,
Gouri Mini
1   Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
,
Tazeen Khan 
1   Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
,
Damarla Haritha
1   Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
,
Koninica Sanyal
1   Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
,
Sulagna Bhattacharjee 
1   Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
,
Dalim K. Baidya 
1   Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
,
Bikash R. Ray
1   Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
,
Rahul K. Anand
1   Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
,
Sudip K. Datta 
2   Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
,
Manish Soneja
3   Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
,
Rajeshwari Subramaniam 
1   Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
,
Souvik Maitra 
1   Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
› Author Affiliations Funding None.
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Abstract

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus-associated pneumonia and acute respiratory distress syndrome (ARDS) were often associated with hyperinflammation and elevation of several serum inflammatory markers but usually less than what is observed in non-coronavirus disease (COVID) ARDS. Elevated inflammatory markers such as C-reactive protein, interleukin (IL)-6, etc., are associated with severe infection. This study identified subphenotypes of COVID-19 ARDS patients by latent profile analysis in a cohort of Indian patients.

Methods Data of n = 233 adult Indian patients with laboratory-confirmed SARS-CoV-2 infection admitted to a tertiary care teaching hospital were analyzed in this retrospective study. Only patients with acute respiratory failure (defined by partial pressure of oxygen/fraction of inspired oxygen ratio < 200 mm Hg) and chest X-ray showing bilateral infiltrates were included.

Results The patients' mean (standard deviation) age was 53.3 (14.9) years, and 62% were male. A two subphenotypic model was formulated based on the lowest Bayesian information criterion. Neutrophil-to-lymphocyte ratio and serum IL-6 were latent variables in that model (entropy 0.91). The second phenotype (hyperinflammatory) had lower platelet count (p = 0.02), higher serum creatinine (p = 0.004), higher C-reactive protein (p = 0.001), higher ferritin (p < 0.001), and serum lactate dehydrogenase (p = 0.009). Age-adjusted hospital mortality (p = 0.007), duration of hospital stay (p < 0.001), and duration of intensive care unit stay (p < 0.001) were significantly higher in the second subphenotype.

Conclusion Two distinct but overlapping subphenotypes were identified in SARS-CoV-2-associated respiratory failure. Hyperinflammatory subphenotype was associated with significantly poor short-term outcomes.

Keywords

ARDS - COVID-19 - SARS-CoV-2 - latent class

Note

Abstract of this manuscript was accepted for presentation in ESICM Lives 2022 held in Paris from 22nd to 26th October.




Publication History

Received: 07 September 2022

Accepted: 26 February 2023

Article published online:
03 July 2023

© 2023. The Indian Association of Laboratory Physicians. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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