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Identification of Distinct Clinical Phenotypes of Critically Ill COVID-19 Patients

2023-04Artigo científico Acesso aberto
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dc.contributor.authorCidade, José Pedro
dc.contributor.authorde Souza Dantas, Vicente Cés
dc.contributor.authorde Figueiredo Thompson, Alessandra
dc.contributor.authorde Miranda, Renata Carnevale Carneiro Chermont
dc.contributor.authorMamfrim, Rafaela
dc.contributor.authorCaroli, Henrique
dc.contributor.authorEscudini, Gabriela
dc.contributor.authorOliveira, Natalia
dc.contributor.authorCastro, Taiza
dc.contributor.authorPóvoa, Pedro
dc.contributor.authorPovoa, Pedro
dc.contributor.institutionNOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
dc.contributor.institutionComprehensive Health Research Centre (CHRC) - pólo NMS
dc.contributor.pblMDPI - Multidisciplinary Digital Publishing Institute
dc.date.accessioned2023-05-12T22:12:08Z
dc.date.available2023-05-12T22:12:08Z
dc.date.issued2023-04
dc.description.abstractPurpose: COVID-19 presents complex pathophysiology, and evidence collected points towards an intricate interaction between viral-dependent and individual immunological mechanisms. Identifying phenotypes through clinical and biological markers may provide a better understanding of the subjacent mechanisms and an early patient-tailored characterization of illness severity. Methods: A multicenter prospective cohort study was performed in 5 hospitals in Portugal and Brazil for one year between 2020–2021. All adult patients with an Intensive Care Unit admission with SARS-CoV-2 pneumonia were eligible. COVID-19 was diagnosed using clinical and radiologic criteria with a SARS-CoV-2 positive RT-PCR test. A two-step hierarchical cluster analysis was made using several class-defining variables. Results: 814 patients were included. The cluster analysis revealed a three-class model, allowing for the definition of three distinct COVID-19 phenotypes: 407 patients in phenotype A, 244 patients in phenotype B, and 163 patients in phenotype C. Patients included in phenotype A were significantly older, with higher baseline inflammatory biomarkers profile, and a significantly higher requirement of organ support and mortality rate. Phenotypes B and C demonstrated some overlapping clinical characteristics but different outcomes. Phenotype C patients presented a lower mortality rate, with consistently lower C-reactive protein, but higher procalcitonin and interleukin-6 serum levels, describing an immunological profile significantly different from phenotype B. Conclusions: Severe COVID-19 patients exhibit three different clinical phenotypes with distinct profiles and outcomes. Their identification could have an impact on patients’ care, justifying different therapy responses and inconsistencies identified across different randomized control trial results.en
dc.description.versionpublishersversion
dc.description.versionpublished
dc.format.extent2499970
dc.identifier.doi10.3390/jcm12083035
dc.identifier.issn2077-0383
dc.identifier.otherPURE: 60176323
dc.identifier.otherPURE UUID: 15a3d23a-a044-4b3a-bf51-e3a8f6c5998b
dc.identifier.otherScopus: 85154597710
dc.identifier.urihttp://hdl.handle.net/10362/152741
dc.identifier.urlhttps://www.scopus.com/pages/publications/85154597710
dc.language.isoeng
dc.peerreviewedyes
dc.subjectcluster analysis
dc.subjectCOVID-19
dc.subjectcritical care
dc.subjectmortality rate
dc.subjectphenotypes
dc.subjectGeneral Medicine
dc.titleIdentification of Distinct Clinical Phenotypes of Critically Ill COVID-19 Patientsen
dc.title.subtitleResults from a Cohort Observational Studyen
dc.typejournal article
degois.publication.issue8
degois.publication.titleJournal of Clinical Medicine
degois.publication.volume12
dspace.entity.typePublication
person.familyNamePovoa
person.givenNamePedro
person.identifier.ciencia-id0C16-5CF9-9238
person.identifier.orcid0000-0002-7069-7304
person.identifier.scopus-author-id6602772147
rcaap.rightsopenAccess
relation.isAuthorOfPublication04ec38ba-be1e-46e5-8007-0e65a557d0f4
relation.isAuthorOfPublication.latestForDiscovery04ec38ba-be1e-46e5-8007-0e65a557d0f4

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