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. 2021 Mar 11:8:632933.
doi: 10.3389/fmed.2021.632933. eCollection 2021.

Identifying Clinical Phenotypes in Moderate to Severe Acute Respiratory Distress Syndrome Related to COVID-19: The COVADIS Study

Jean-Baptiste Lascarrou  1 , Aurelie Gaultier  2 , Thibaud Soumagne  3 , Nicolas Serck  4 , Bertrand Sauneuf  5 , Michael Piagnerelli  6 , Andre Ly  7 , Francois Lejeune  8 , Laurent Lefebvre  9 , Sami Hraiech  10   11 , Geoffrey Horlait  12 , Julien Higny  13 , Alain D'hondt  14 , Stephane Gaudry  15 , Romain Courcelle  16 , Giuseppe Carbutti  17 , Gauthier Blonz  18 , Gregoire Ottavy  1 , Nadia Aissaoui  19 , Christophe Vinsonneau  20 , Benoit Vandenbunder  21 , Julien Textoris  22   23 , Piotr Szychowiak  24   25   26 , David Grimaldi  27 ; COVADIS study group
Affiliations

Identifying Clinical Phenotypes in Moderate to Severe Acute Respiratory Distress Syndrome Related to COVID-19: The COVADIS Study

Jean-Baptiste Lascarrou et al. Front Med (Lausanne). .

Abstract

Objectives: Different phenotypes have been identified in acute respiratory distress syndrome (ARDS). Existence of several phenotypes in coronavirus disease (COVID-19) related acute respiratory distress syndrome is unknown. We sought to identify different phenotypes of patients with moderate to severe ARDS related to COVID-19. Methods: We conducted an observational study of 416 COVID-19 patients with moderate to severe ARDS at 21 intensive care units in Belgium and France. The primary outcome was day-28 ventilatory free days. Secondary outcomes were mortality on day 28, acute kidney injury, acute cardiac injury, pulmonary embolism, and deep venous thrombosis. Multiple factor analysis and hierarchical classification on principal components were performed to distinguish different clinical phenotypes. Results: We identified three different phenotypes in 150, 176, and 90 patients, respectively. Phenotype 3 was characterized by short evolution, severe hypoxemia, and old comorbid patients. Phenotype 1 was mainly characterized by the absence of comorbidities, relatively high compliance, and long duration of symptoms, whereas phenotype 2 was characterized female sex, and the presence of mild comorbidities such as uncomplicated diabetes or chronic hypertension. The compliance in phenotype 2 was lower than that in phenotype 1, with higher plateau and driving pressure. Phenotype 3 was associated with higher mortality compared to phenotypes 1 and 2. Conclusions: In COVID-19 patients with moderate to severe ARDS, we identified three clinical phenotypes. One of these included older people with comorbidities who had a fulminant course of disease with poor prognosis. Requirement of different treatments and ventilatory strategies for each phenotype needs further investigation.

Keywords: ARDS; COVID-19; intubation; mechanical ventilation; phenotype.

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Conflict of interest statement

JT is a part-time employee of bioMérieux, an IVD company, and Hospices Civils de Lyon, a university hospital. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Hierarchical clustering tree (panel A), bar plot of inertia gains (panel A), and factor map of candidates' characteristics (panel B).
Figure 2
Figure 2
Probability of dying or being weaned over time during 28 days.
See this image and copyright information in PMC

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